Provider Demographics
NPI:1437321916
Name:TASICH, LJUBISA (HEARING AID DEALER)
Entity Type:Individual
Prefix:MR
First Name:LJUBISA
Middle Name:
Last Name:TASICH
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3472
Mailing Address - Country:US
Mailing Address - Phone:586-604-5558
Mailing Address - Fax:248-608-4612
Practice Address - Street 1:200 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1208
Practice Address - Country:US
Practice Address - Phone:586-604-5558
Practice Address - Fax:248-608-4612
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004651237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
EYEMEDOther110955
900E06513OtherBCBS
EYEMEDOther110955