Provider Demographics
NPI:1699737494
Name:MCKEOWN, PETER PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:PHILIP
Last Name:MCKEOWN
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:PO BOX 73652
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:859-313-2758
Mailing Address - Fax:859-276-5939
Practice Address - Street 1:1406 W 5TH ST
Practice Address - Street 2:STE 303
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-862-9280
Practice Address - Fax:859-862-9290
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01855208G00000X, 208600000X, 2086S0102X
KY41559208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care