Provider Demographics
NPI:1821525429
Name:DUFENDACH, KEITH ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLEN
Last Name:DUFENDACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1560 E SHERMAN BLVD STE 309
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1850
Mailing Address - Country:US
Mailing Address - Phone:231-672-8643
Mailing Address - Fax:231-672-8651
Practice Address - Street 1:1560 E SHERMAN BLVD STE 309
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1850
Practice Address - Country:US
Practice Address - Phone:231-672-8643
Practice Address - Fax:231-672-8651
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301513912208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program