Healthcare Provider Details

I. General information

NPI: 1679152706
Provider Name (Legal Business Name): KEILMAN HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E ELM AVE STE 111
MONROE MI
48162-2678
US

IV. Provider business mailing address

214 E ELM AVE STE 111
MONROE MI
48162-2678
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-4080
  • Fax: 734-241-4798
Mailing address:
  • Phone: 734-241-4080
  • Fax: 734-241-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON WAYNE KEILMAN
Title or Position: AUDIOPROTHOLOGIST/OWNER
Credential: A.C.A, NBC-HIS
Phone: 734-241-4080