Healthcare Provider Details

I. General information

NPI: 1932348877
Provider Name (Legal Business Name): KRESGE EYE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 SAINT ANTOINE ST
DETROIT MI
48201-1423
US

IV. Provider business mailing address

436 W BRECKENRIDGE ST
FERNDALE MI
48220-1726
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-8900
  • Fax: 313-577-9675
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number4301093190
License Number StateMI

VIII. Authorized Official

Name: MRS. DEBORAH CHESNEY
Title or Position: RESIDENCY PROGRAM COORDINATOR
Credential:
Phone: 313-577-7614