Provider Demographics
NPI:1114198157
Name:INNOVATIVE HEARING SERVICES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE HEARING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:BAZELL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-A/FAAA
Authorized Official - Phone:248-544-0560
Mailing Address - Street 1:2766 W 11 MILE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3033
Mailing Address - Country:US
Mailing Address - Phone:248-544-0560
Mailing Address - Fax:248-544-7480
Practice Address - Street 1:2766 W 11 MILE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3033
Practice Address - Country:US
Practice Address - Phone:248-544-0560
Practice Address - Fax:248-544-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000293231H00000X
MI3501002743237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP15350Medicare PIN