MEDICARE: DR. JEFFREY A DISKIN M.D.

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	207W00000X	Ophthalmology Physician	JD051789	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518962836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY A DISKIN M.D.

Provider Business Mailing Address
First Line	:	5449 AVALON COURT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 SE RIVERSIDE DR STE 302
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2579
Country	:	US
Telephone Number	:	772-287-9000
Fax Number	:	772-287-0507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/28/2026

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