Provider Demographics
NPI:1043549140
Name:INNOVATIVE EAR & HEARING
Entity type:Organization
Organization Name:INNOVATIVE EAR & HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTIG
Authorized Official - Suffix:
Authorized Official - Credentials:BC/HIS
Authorized Official - Phone:586-991-0450
Mailing Address - Street 1:43184 DEQUINDRE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:586-991-0450
Mailing Address - Fax:
Practice Address - Street 1:43184 DEQUINDRE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-991-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002668237700000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty