1871926543 NPI number — DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE

Table of content: STEPHANIE MOUY EAR RN (NPI 1518715218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871926543 NPI number — DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871926543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4499 TOWN CENTER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-7111
Provider Business Mailing Address Fax Number:
810-733-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4499 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-733-7111
Provider Business Practice Location Address Fax Number:
810-733-7141
Provider Enumeration Date:
08/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
810-733-7111

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  GK407137 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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