Provider Demographics
NPI:1285631986
Name:KEY DIABETES SUPPLY CO
Entity Type:Organization
Organization Name:KEY DIABETES SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIETZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-541-7930
Mailing Address - Street 1:11585 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-5729
Mailing Address - Country:US
Mailing Address - Phone:877-541-7930
Mailing Address - Fax:877-541-7931
Practice Address - Street 1:11585 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-5729
Practice Address - Country:US
Practice Address - Phone:877-541-7930
Practice Address - Fax:877-541-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4415845Medicaid
MI4415845Medicaid