Provider Demographics
NPI:1316968423
Name:SEAN KEANE M.D. S.C.
Entity type:Organization
Organization Name:SEAN KEANE M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-277-1115
Mailing Address - Street 1:2315 N LAKE DR
Mailing Address - Street 2:SUITE 803
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4518
Mailing Address - Country:US
Mailing Address - Phone:414-277-1115
Mailing Address - Fax:414-277-1126
Practice Address - Street 1:2315 N LAKE DR
Practice Address - Street 2:SUITE 803
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4518
Practice Address - Country:US
Practice Address - Phone:414-277-1115
Practice Address - Fax:414-277-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17123-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30941800Medicaid
WI30941800Medicaid