Provider Demographics
NPI:1972606184
Name:KEITH, SCOTT N (DPM)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:N
Last Name:KEITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:37 KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1057
Mailing Address - Country:US
Mailing Address - Phone:219-306-7121
Mailing Address - Fax:219-937-0203
Practice Address - Street 1:12800 MISSISSIPPI PKWY
Practice Address - Street 2:PAVILLION C, SUITE 101
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-6900
Practice Address - Country:US
Practice Address - Phone:219-769-2141
Practice Address - Fax:219-769-2675
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN07000389213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34986Medicare UPIN
IN206810Medicare PIN