Provider Demographics
NPI:1013140136
Name:DESOUSA, KEITH GARCIA (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:GARCIA
Last Name:DESOUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:270 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8420
Mailing Address - Country:US
Mailing Address - Phone:631-591-7470
Mailing Address - Fax:631-591-7472
Practice Address - Street 1:300 RIVERSIDE DR E STE 1100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1022
Practice Address - Country:US
Practice Address - Phone:941-867-2111
Practice Address - Fax:941-702-4204
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2724032084N0400X, 2084V0102X, 2085N0700X
FLME1126572084N0400X, 2084V0102X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology