Provider Demographics
NPI:1215108147
Name:MIRACLE EAR
Entity type:Organization
Organization Name:MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:VOTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-421-1688
Mailing Address - Street 1:12737 RIVERDALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1253
Mailing Address - Country:US
Mailing Address - Phone:763-421-1688
Mailing Address - Fax:
Practice Address - Street 1:3001 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1080
Practice Address - Country:US
Practice Address - Phone:651-770-5873
Practice Address - Fax:651-747-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty