Provider Demographics
NPI:1780210518
Name:TODERAN, KIP N
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:N
Last Name:TODERAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W UNIVERSITY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1955
Mailing Address - Country:US
Mailing Address - Phone:248-608-8881
Mailing Address - Fax:
Practice Address - Street 1:134 W UNIVERSITY DR STE 203
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1955
Practice Address - Country:US
Practice Address - Phone:248-608-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501010879237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist