MEDICARE: MICHAEL E KEEFE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	42858	WI

General Provider Information

NPI Number	:	1073510004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E KEEFE MD

Provider Business Mailing Address
First Line	:	4425 N PORT WASHINGTON RD
Second Line	:	ATTN: CSMCP CLINIC CREDENTIALING
City	:	GLENDALE
State	:	WI
Zip	:	53212-1082
Country	:	US
Telephone Number	:	414-298-7250
Fax Number	:	414-298-7251

Provider Business Practice Location Address
First Line	:	2350 N LAKE DR
Second Line	:	SUITE 100
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4528
Country	:	US
Telephone Number	:	414-298-7250
Fax Number	:	414-298-7251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/11/2012

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