Provider Demographics
NPI:1578918694
Name:FLUKE, TREVER WILLIAM (HIS)
Entity Type:Individual
Prefix:MR
First Name:TREVER
Middle Name:WILLIAM
Last Name:FLUKE
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 1:4025 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9644
Mailing Address - Country:US
Mailing Address - Phone:734-477-9907
Mailing Address - Fax:345-475-7207
Practice Address - Street 1:4025 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9644
Practice Address - Country:US
Practice Address - Phone:734-477-9907
Practice Address - Fax:734-477-9908
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004646237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist