Provider Demographics
NPI:1518175017
Name:KUETTEL, MIKE B (HAD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:B
Last Name:KUETTEL
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:003-288-6028
Mailing Address - Fax:952-285-3980
Practice Address - Street 1:319 S POWER RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5295
Practice Address - Country:US
Practice Address - Phone:480-325-9097
Practice Address - Fax:480-924-7930
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1878237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist