MEDICARE: MRS. GYL A. KASEWURM AUD, FAAA

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	1601000002	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811991771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GYL A. KASEWURM AUD, FAAA

Provider Business Mailing Address
First Line	:	511 RENAISSANCE DR
Second Line	:	STE 100
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2180
Country	:	US
Telephone Number	:	269-982-3444
Fax Number	:	269-982-3445

Provider Business Practice Location Address
First Line	:	511 RENAISSANCE DR
Second Line	:	STE 100
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2180
Country	:	US
Telephone Number	:	269-982-3444
Fax Number	:	269-982-3445

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/12/2011

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