Provider Demographics
NPI:1982698031
Name:KEIDAN, RICHARD DAVID (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:KEIDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3577 W 13 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-551-2414
Mailing Address - Fax:248-435-4566
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-2414
Practice Address - Fax:248-435-4566
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK0451432086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P75686OtherBCN
B8320OtherMCERE
P00180696OtherRR MEDICARE
B41363Medicare UPIN
P75686OtherBCN