Provider Demographics
NPI:1467706556
Name:DEYARMAN, MICHAEL T (HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:DEYARMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SYLVANIA AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3937
Mailing Address - Country:US
Mailing Address - Phone:419-517-7794
Mailing Address - Fax:419-967-6935
Practice Address - Street 1:6600 SYLVANIA AVE STE 17
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3937
Practice Address - Country:US
Practice Address - Phone:419-517-7794
Practice Address - Fax:419-967-6935
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2902237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist