Provider Demographics
NPI:1609274455
Name:AUDIOLOGICAL SERVICES OF CADILLAC
Entity Type:Organization
Organization Name:AUDIOLOGICAL SERVICES OF CADILLAC
Other - Org Name:AUDIOLOGICAL SERVICES OF CADILLAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-779-6260
Mailing Address - Street 1:8872 PROFESSIONAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8481
Mailing Address - Country:US
Mailing Address - Phone:231-779-6260
Mailing Address - Fax:231-779-6264
Practice Address - Street 1:8872 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8481
Practice Address - Country:US
Practice Address - Phone:231-779-6260
Practice Address - Fax:231-779-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548562978Medicaid
MIMI3860Medicare PIN