Provider Demographics
NPI:1316383391
Name:KEYES, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NE 17TH TER APT 711
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1127
Mailing Address - Country:US
Mailing Address - Phone:352-359-5042
Mailing Address - Fax:
Practice Address - Street 1:730 NW 107TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3104
Practice Address - Country:US
Practice Address - Phone:305-564-7007
Practice Address - Fax:305-847-0425
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA192179208200000X
FLME155111208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100598000Medicaid