MEDICARE: CHICAGO HEARING AID CTR INC

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	332S00000X	Hearing Aid Equipment

General Provider Information

NPI Number	:	1750555751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO HEARING AID CTR INC

Provider Business Mailing Address
First Line	:	123 W MADISON ST STE 1705
Second Line	:	CHICAGO HEARING AID CTR
City	:	CHICAGO
State	:	IL
Zip	:	60602-4503
Country	:	US
Telephone Number	:	312-782-8177
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W MADISON ST STE 1705
Second Line	:	CHICAGO HEARING AID CTR
City	:	CHICAGO
State	:	IL
Zip	:	60602-4503
Country	:	US
Telephone Number	:	312-782-8177
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	MR. SAM WIDRAN
Credential	:
Telephone Number	:	312-782-8177

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/28/2008

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