MEDICARE: JODY MEDVEDIK M.S.,CCC-A

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	A.02414	OH
2	231H00000X	Audiologist	000358	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	640H224420	OTHER	MI	BCBSM NUMBER

General Provider Information

NPI Number	:	1851413462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY MEDVEDIK M.S.,CCC-A

Provider Business Mailing Address
First Line	:	100 CROSSING BLVD STE 300
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01702-5555
Country	:	US
Telephone Number	:	617-964-6681
Fax Number	:	339-686-2561

Provider Business Practice Location Address
First Line	:	120 N WASHINGTON SQ OFC 378
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-1617
Country	:	US
Telephone Number	:	888-964-6681
Fax Number	:	888-662-0859

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/16/2022

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