Provider Demographics
NPI:1427057603
Name:ROCKEY, KEITH E (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:ROCKEY
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 1:4110 E FOREST GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-9552
Mailing Address - Country:US
Mailing Address - Phone:574-253-1901
Mailing Address - Fax:
Practice Address - Street 1:4110 E FOREST GLEN AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:IN
Practice Address - Zip Code:46538-9552
Practice Address - Country:US
Practice Address - Phone:574-253-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039062A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200006410AMedicaid
IL609080OtherMEDICARE
IN300064852OtherRAILROAD MEDICARE
IN000000192998OtherBC BS
IN000000082191OtherBC BS
IN300127023OtherRAILROAD MEDICARE
IL036123721OtherMEDICAID
IL609330OtherMEDICARE
IN000000192998OtherBC BS
IL609330OtherMEDICARE
E86730Medicare UPIN