Provider Demographics
NPI:1508333113
Name:LAWLESS, MICHAEL A (HEARING AID DEALER)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:LAWLESS
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 1:405 E HOFFER ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2247
Mailing Address - Country:US
Mailing Address - Phone:765-457-1553
Mailing Address - Fax:
Practice Address - Street 1:405 E HOFFER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2247
Practice Address - Country:US
Practice Address - Phone:765-457-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001250A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1700125AOtherHEARING AID DEALER