MEDICARE: HAYDEN ELLERY GURMAN

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	237700000X	Hearing Instrument Specialist	17001404	IN

General Provider Information

NPI Number	:	1851797088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYDEN ELLERY GURMAN

Provider Business Mailing Address
First Line	:	1523 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219
Country	:	US
Telephone Number	:	317-899-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-899-4511
Fax Number	:

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

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	11/17/2014

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