Individual
MEL GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AU.D.
Contact information
Practice address
3540 FOREST HILL BLVD, STE 205, WEST PALM BEACH, FL 33406-5878
(561) 649-4006
(561) 969-6621
Mailing address
3540 FOREST HILL BLVD, STE 205, WEST PALM BEACH, FL 33406-5878
(561) 649-4006
(561) 969-6621
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY151
FL
237600000X
Audiologist-Hearing Aid Fitter
AY 151
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085230900
—
FL
05
—
600037100
—
FL
01
—
640001185
RAILROAD MEDICARE
FL
01
—
J0372
BCBS
FL
01
—
S0526
BCBS
FL
01
—
T0938
BCBS GROUP
FL
Enumeration date
05/27/2005
Last updated
12/05/2014
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