Basic Information
| Provider Information | |||||||||
| NPI: | 1780883710 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIRACLE EAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE LN N | ||||||||
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| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883339152 | ||||||||
| FaxNumber: | 7632684240 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 ADAMS ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560014864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073885624 | ||||||||
| FaxNumber: | 5073883462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | D'AMICO | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CRENDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8883339152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.