Provider Demographics
NPI:1598133456
Name:SUBURBAN HEARING CLINIC, INC.
Entity Type:Organization
Organization Name:SUBURBAN HEARING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTLEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-845-4714
Mailing Address - Street 1:20 W CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2972
Mailing Address - Country:US
Mailing Address - Phone:248-845-4714
Mailing Address - Fax:248-282-4280
Practice Address - Street 1:20 W CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2972
Practice Address - Country:US
Practice Address - Phone:248-845-4714
Practice Address - Fax:248-282-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501005129332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment