MEDICARE: DR. BRUCE M EDWARDS AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist
2	231H00000X	Audiologist	1601000035	MI

General Provider Information

NPI Number	:	1750389136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE M EDWARDS AU.D.

Provider Business Mailing Address
First Line	:	3621 SOUTH STATE STREET
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MI
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 EAST MEDICAL CENTER DR
Second Line	:	1ST FLOOR TAUBMAN CENTER RECP A
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-5312
Country	:	US
Telephone Number	:	734-936-8051
Fax Number	:	734-936-8052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	12/12/2013

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