Provider Demographics
NPI:1184079204
Name:COREY, MICHAEL DAVID (HIT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:COREY
Suffix:
Gender:M
Credentials:HIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 HENRY ST SUITE #102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-733-2008
Mailing Address - Fax:231-733-2010
Practice Address - Street 1:2397 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1521
Practice Address - Country:US
Practice Address - Phone:517-783-5853
Practice Address - Fax:517-783-5863
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501006800247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBUBBACOREY7OtherAMERICAN HEARING BENEFIT