Healthcare Provider Details

I. General information

NPI: 1588667752
Provider Name (Legal Business Name): KEITH ANDREW KOBET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7949 N CANTON CENTER RD
CANTON MI
48187-1533
US

IV. Provider business mailing address

7949 N CANTON CENTER RD
CANTON MI
48187-1533
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-7850
  • Fax: 734-459-5799
Mailing address:
  • Phone: 734-459-7850
  • Fax: 734-459-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301038029
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: