Organization
HEARING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP N HEISTAD (OWNER)
(715) 627-4199
Entity
Organization
Contact information
Practice address
723 SUPERIOR ST, ANTIGO, WI 54409-2011
(715) 627-4199
Mailing address
PO BOX 185, ANTIGO, WI 54409-0185
(715) 627-4199
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
1182 060
WI
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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