MEDICARE: RANDI JEAN KEEFE D.P.M.

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	213E00000X	Podiatrist	36.003959	OH

General Provider Information

NPI Number	:	1326571308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI JEAN KEEFE D.P.M.

Provider Business Mailing Address
First Line	:	161 E WASHINGTON ST
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-3449
Country	:	US
Telephone Number	:	440-352-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 E WASHINGTON ST
Second Line	:
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-3449
Country	:	US
Telephone Number	:	440-352-2201
Fax Number	:	440-352-0242

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/02/2024

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