Basic Information
| Provider Information | |||||||||
| NPI: | 1467108761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | GARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 S 5TH ST STE 2300 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554024223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632684000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 133 ALTAMA CONNECTOR | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315251888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122653833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2022 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.