Doctor Name: | DR. THOMAS W KEAVENEY |
NPI Number: | 1629410725 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4301060467 |
Business Practice Address: | 1322 E Michigan Ave Suite 101 Lansing, MI - 489122199 |
Business Phone Number: | 5173643900 |
Business Fax Number: | 5173643514 |
Mailing Address: | 1322 E Michigan Ave, Suite 101 LANSING |
State: | MI |
Postal Code: | 489122199 |
Phone Number: | 5173643900 |
Fax Number: | 5173643514 |
NPI Enumeration Date: | 07/18/2013 |
NPI Last Update Date: | 07/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301060467 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |