MEDICARE: MARGO DANIELLE KEANE LM, CPM

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	176B00000X	Midwife	MW345	FL

General Provider Information

NPI Number	:	1114450558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGO DANIELLE KEANE LM, CPM

Provider Business Mailing Address
First Line	:	126 43RD AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-2382
Country	:	US
Telephone Number	:	772-217-4471
Fax Number	:	772-217-4472

Provider Business Practice Location Address
First Line	:	126 43RD AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-2382
Country	:	US
Telephone Number	:	772-217-4471
Fax Number	:	772-217-4472

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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