Provider Demographics
NPI:1003564253
Name:MIHTAR, HARWON M
Entity Type:Individual
Prefix:
First Name:HARWON
Middle Name:M
Last Name:MIHTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28542 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2842
Mailing Address - Country:US
Mailing Address - Phone:734-219-4327
Mailing Address - Fax:313-344-1880
Practice Address - Street 1:28542 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2842
Practice Address - Country:US
Practice Address - Phone:734-219-4327
Practice Address - Fax:313-344-1880
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3503013739237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist