MEDICARE: STEVENS ENTERPRISES 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	1637	IL

General Provider Information

NPI Number	:	1841599263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVENS ENTERPRISES INC.

Provider Business Mailing Address
First Line	:	12910 S LA GRANGE RD
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-1717
Country	:	US
Telephone Number	:	708-448-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	12910 S LA GRANGE RD
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-1717
Country	:	US
Telephone Number	:	708-448-1234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL J STEVENS
Credential	:	BC-HIS
Telephone Number	:	708-448-1234

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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