Provider Demographics
NPI:1750555751
Name:CHICAGO HEARING AID CTR INC
Entity type:Organization
Organization Name:CHICAGO HEARING AID CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-782-8177
Mailing Address - Street 1:123 W MADISON ST STE 1705
Mailing Address - Street 2:CHICAGO HEARING AID CTR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4503
Mailing Address - Country:US
Mailing Address - Phone:312-782-8177
Mailing Address - Fax:
Practice Address - Street 1:123 W MADISON ST STE 1705
Practice Address - Street 2:CHICAGO HEARING AID CTR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4503
Practice Address - Country:US
Practice Address - Phone:312-782-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid