Individual
MRS. SANDRA J PRYTULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21000 E 12 MILE RD, SUITE 111, SAINT CLAIR SHORES, MI 48081-1116
(586) 779-7610
Mailing address
21000 E 12 MILE RD, STE 111, ST CLAIR SHORES, MI 48081
(586) 779-7610
(586) 445-2526
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
1601000065
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E01107
BLUE SHIELD
—
01
—
0E06192
BLUE SHIELD
MI
01
—
540E00292
BLUE SHIELD
MI
01
—
640E07684
BLUE SHIELD
MI
Enumeration date
10/10/2006
Last updated
12/23/2008
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