Provider Demographics
NPI:1275700734
Name:DILLER, MICHI SU (AUD)
Entity Type:Individual
Prefix:
First Name:MICHI
Middle Name:SU
Last Name:DILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MICHI
Other - Middle Name:SU
Other - Last Name:ADELMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:14040 BOYSTOWN HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7521
Practice Address - Country:US
Practice Address - Phone:402-778-6800
Practice Address - Fax:402-778-6874
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE107237600000X
NE287231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100222Medicare PIN