Provider Demographics
NPI:1104812676
Name:KEENER, DON E (MD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:E
Last Name:KEENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 KIMOLE LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1478
Mailing Address - Country:US
Mailing Address - Phone:517-263-5655
Mailing Address - Fax:517-263-8012
Practice Address - Street 1:777 KIMOLE LN
Practice Address - Street 2:SUITE 230
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1478
Practice Address - Country:US
Practice Address - Phone:517-263-5655
Practice Address - Fax:517-263-8012
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0804646101OtherBCBS MI
MI4783556Medicaid
113265OtherCARECHOICE/PREFERRED CHOI
P00254437OtherRRMC
276465525OtherHNFS
03651OtherPARAMOUNT
MI0461389Medicaid
276465525-001OtherMMO
4486102OtherAETNA
000000387440OtherANTHEM
P00254437OtherRRMC
113265OtherCARECHOICE/PREFERRED CHOI