MEDICARE: KATHERINE ANN KEITH M.D.

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	207R00000X	Internal Medicine Physician	4301081055	MI
2	208000000X	Pediatrics Physician	4301081055	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P17270001	OTHER	MI	MEDICARE INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1902086689	OTHER	MI	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700A146860	OTHER	MI	BCBSM GROUP PIN

General Provider Information

NPI Number	:	1104806116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN KEITH M.D.

Provider Business Mailing Address
First Line	:	9045 US HIGHWAY 31
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1804
Country	:	US
Telephone Number	:	269-473-2222
Fax Number	:	269-473-6880

Provider Business Practice Location Address
First Line	:	9045 US HIGHWAY 31
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1804
Country	:	US
Telephone Number	:	269-473-2222
Fax Number	:	269-473-6880

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	11/26/2019

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Directions to “ KATHERINE ANN KEITH M.D.” Practice Location

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