Provider Demographics
NPI:1073950846
Name:MCKEOWN, ADAM PAUL (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:PAUL
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:PAUL
Other - Last Name:MCKEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:565 PLAYA LINDA PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7524
Mailing Address - Country:US
Mailing Address - Phone:231-329-2397
Mailing Address - Fax:
Practice Address - Street 1:4001 S DECATUR BLVD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5857
Practice Address - Country:US
Practice Address - Phone:702-710-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3042207R00000X
MDH0082254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine