Provider Demographics
NPI:1164609038
Name:BEYER, DENNIS JEROME (HIS HEARING INSTRUME)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JEROME
Last Name:BEYER
Suffix:
Gender:M
Credentials:HIS HEARING INSTRUME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N ST JOSEPH AVE
Mailing Address - Street 2:MIRACLE EAR
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449
Mailing Address - Country:US
Mailing Address - Phone:715-384-0944
Mailing Address - Fax:
Practice Address - Street 1:177 DIVISION ST
Practice Address - Street 2:MIRACLE EAR
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552
Practice Address - Country:US
Practice Address - Phone:715-762-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42830100Medicaid