MEDICARE: DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	GK407137	MI

General Provider Information

NPI Number	:	1467885970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISKIN DISKIN & KEOLEIAN DBA MICHIGAN EYE INSTITUTE

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

Provider Business Practice Location Address
First Line	:	8275 HOLLY RD
Second Line	:	SUITE 3
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2442
Country	:	US
Telephone Number	:	810-694-8400
Fax Number	:	810-694-8564

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MR. BRIAN HAYES
Credential	:
Telephone Number	:	810-733-7111

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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