Provider Demographics
NPI:1588707301
Name:KADE, MARINA ELENA (AUD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ELENA
Last Name:KADE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3626
Mailing Address - Country:US
Mailing Address - Phone:586-558-7477
Mailing Address - Fax:586-558-7479
Practice Address - Street 1:8617 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3626
Practice Address - Country:US
Practice Address - Phone:586-558-7477
Practice Address - Fax:586-558-7479
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI160100076237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N89350Medicare ID - Type UnspecifiedAUDIOLOGIST