Provider Demographics
NPI:1124395959
Name:SULIK, TAMARA (HIS)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SULIK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:QUALITY HEARING
Other - Middle Name:
Other - Last Name:CENTER INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22391 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1860
Mailing Address - Country:US
Mailing Address - Phone:313-551-5526
Mailing Address - Fax:313-914-3876
Practice Address - Street 1:22391 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1860
Practice Address - Country:US
Practice Address - Phone:313-551-5526
Practice Address - Fax:313-914-3876
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002701237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326378886OtherGROUP NPI