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NPI Code Detail

MEDICARE: DR. ELINA BAGDASARYAN AU.D.

MEDICARE: DR. ELINA BAGDASARYAN AU.D.
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
1231H00000XAudiologistL1293035MI

General Provider Information

NPI Number : 1982867610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELINA BAGDASARYAN AU.D.
Provider Business Mailing Address
First Line : 30055 NORTHWESTERN HWY STE 101
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-3260
Country : US
Telephone Number : 248-766-6319
Fax Number :
Provider Business Practice Location Address
First Line : 30055 NORTHWESTERN HWY STE 101
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-3260
Country : US
Telephone Number : 248-865-4444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2008
Last Update Date : 07/02/2008

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