Provider Demographics
NPI:1285615906
Name:GINSBERG, KEITH D (DO)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1760 E BOSTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6241
Mailing Address - Country:US
Mailing Address - Phone:480-355-8180
Mailing Address - Fax:480-355-8844
Practice Address - Street 1:3011 S LINDSAY RD STE 110
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4334
Practice Address - Country:US
Practice Address - Phone:480-355-8180
Practice Address - Fax:480-355-8844
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2020-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z101779Medicare PIN
AZH19359Medicare UPIN