Provider Demographics
NPI:1225209174
Name:MIRACLE EAR
Entity Type:Organization
Organization Name:MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:VOTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:763-421-1688
Mailing Address - Street 1:1611 COUNTY ROAD B W
Mailing Address - Street 2:SUITE #204
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5021
Mailing Address - Country:US
Mailing Address - Phone:657-631-9363
Mailing Address - Fax:651-639-0896
Practice Address - Street 1:1611 W COUNTY RD B
Practice Address - Street 2:SUITE 204
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-631-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty