Provider Demographics
NPI:1386799237
Name:BLAKELY, KEITH ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:237 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2874
Mailing Address - Country:US
Mailing Address - Phone:614-627-1410
Mailing Address - Fax:614-627-1413
Practice Address - Street 1:237 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2874
Practice Address - Country:US
Practice Address - Phone:614-627-1410
Practice Address - Fax:614-627-1413
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA16902Medicare UPIN