Basic Information
| Provider Information | |||||||||
| NPI: | 1871926543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4499 TOWN CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337111 | ||||||||
| FaxNumber: | 8107337141 | ||||||||
| Practice Location | |||||||||
| Address1: | 4499 TOWN CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107337111 | ||||||||
| FaxNumber: | 8107337141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8107337111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | GK407137 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.