MEDICARE: MIRACLE EAR

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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1932387305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE EAR

Provider Business Mailing Address
First Line	:	5000 CHESHIRE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-3706
Country	:	US
Telephone Number	:	888-333-9152
Fax Number	:	763-268-4240

Provider Business Practice Location Address
First Line	:	1402 S PARKER RD
Second Line	:	SUITE A-106
City	:	DENVER
State	:	CO
Zip	:	80231-2758
Country	:	US
Telephone Number	:	303-755-1733
Fax Number	:	303-306-9340

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAUL M D'AMICO
Credential	:
Telephone Number	:	888-333-9152

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	08/27/2009

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