Basic Information
| Provider Information | |||||||||
| NPI: | 1104812676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEENER | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 KIMOLE LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172635655 | ||||||||
| FaxNumber: | 5172638012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301034072 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0804646101 | 01 | BCBS MI | OTHER | 4783556 | 05 | MI | MEDICAID | 113265 | 01 | CARECHOICE/PREFERRED CHOI | OTHER | P00254437 | 01 | RRMC | OTHER | 276465525 | 01 | HNFS | OTHER | 03651 | 01 | PARAMOUNT | OTHER | 0461389 | 05 | MI | MEDICAID | 276465525-001 | 01 | MMO | OTHER | 4486102 | 01 | AETNA | OTHER | 000000387440 | 01 | ANTHEM | OTHER |