Provider Demographics
NPI:1467475897
Name:HAWA, ELIAS M (MCH,CCC-A,FAAA)
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:M
Last Name:HAWA
Suffix:
Gender:M
Credentials:MCH,CCC-A,FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NEW TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7966
Mailing Address - Country:US
Mailing Address - Phone:270-782-7768
Mailing Address - Fax:270-781-9480
Practice Address - Street 1:340 NEW TOWNE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7966
Practice Address - Country:US
Practice Address - Phone:270-782-7768
Practice Address - Fax:270-781-9480
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY161237600000X
KY8A237600000X
KY8231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400034600Medicare PIN