Provider Demographics
NPI:1609939925
Name:GEORGE IWANOW HEARING AID CENTERS INC
Entity Type:Organization
Organization Name:GEORGE IWANOW HEARING AID CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IWANOW
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DEALER
Authorized Official - Phone:586-263-4401
Mailing Address - Street 1:19991 HALL RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4254
Mailing Address - Country:US
Mailing Address - Phone:586-263-4401
Mailing Address - Fax:586-263-4402
Practice Address - Street 1:19991 HALL RD
Practice Address - Street 2:STE. 102
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4254
Practice Address - Country:US
Practice Address - Phone:586-263-4401
Practice Address - Fax:586-263-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI350L000203237700000X
MI3501000203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
540E004930OtherBCBS