Provider Demographics
NPI:1316948409
Name:HEWEL, KEITH C (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:HEWEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1829
Mailing Address - Country:US
Mailing Address - Phone:208-666-3200
Mailing Address - Fax:208-666-3397
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-666-3200
Practice Address - Fax:208-666-3217
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-68042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1134798OtherCIGNA MEDICARE- RANI
IDB1279OtherBC ID - PF
IDP00099930OtherRR MEDICARE - RANI
ID003724900Medicaid
ID300068472OtherRR MEDICARE
WA8218695Medicaid
IDDD537OtherBC ID - RANI
IDDD545OtherBC ID - CDA
ID300068472OtherRR MEDICARE
ID1134793Medicare ID - Type UnspecifiedCIGNA MEDICARE - NIIC