Provider Demographics
NPI:1972147650
Name:WARREN, MICHAEL T (HIS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:WARREN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 3 MILE RD NW OFC D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1650
Mailing Address - Country:US
Mailing Address - Phone:616-538-5300
Mailing Address - Fax:616-538-5006
Practice Address - Street 1:5025 W SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2656
Practice Address - Country:US
Practice Address - Phone:517-657-7184
Practice Address - Fax:517-708-7454
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004749237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist