Provider Demographics
NPI:1316969066
Name:WASHINGTON-KEELING, DONNA J (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:WASHINGTON-KEELING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:1525 W CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9686
Practice Address - Country:US
Practice Address - Phone:989-671-2100
Practice Address - Fax:989-671-2120
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW045612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDW045612OtherSTATE LICENSE
MI5221891Medicaid
MIP00651228OtherRR MEDICARE
MI1689022469Medicaid
MI1659326395Medicaid
MIP00651228OtherRR MEDICARE
P39040025Medicare PIN