Organization
HAGEMAN AUDIOLOGY & HEARING AIDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD G HAGEMAN AUD (PRESIDENT)
(616) 285-3733
Entity
Organization
Contact information
Practice address
2505 EAST PARIS AVE SE, SUITE 170, GRAND RAPIDS, MI 49546-2422
(616) 285-3733
(616) 288-3745
Mailing address
2505 EAST PARIS AVE SE, SUITE 170, GRAND RAPIDS, MI 49546-2422
(616) 285-3733
(616) 288-3745
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
1601000046
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4847180
—
MI
01
—
4956943
MEDICAID TYPE 90
MI
01
—
640D115780
BLUE CROSS BLUE SHIELD
MI
Enumeration date
05/12/2008
Last updated
05/29/2014
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