Healthcare Provider Details

I. General information

NPI: 1013411883
Provider Name (Legal Business Name): JASON WAYNE KEILMAN ACA, NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON WAYNE KEILMAN ACA

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10982 MIDDLEBELT RD
LIVONIA MI
48150-3058
US

IV. Provider business mailing address

10982 MIDDLEBELT RD
LIVONIA MI
48150-3058
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-6300
  • Fax: 734-261-5116
Mailing address:
  • Phone: 734-261-6300
  • Fax: 734-261-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number3501003237
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501003237
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: