MEDICARE: DAVID K. KEITH, D.O., LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508844721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID K. KEITH, D.O., LLC

Provider Business Mailing Address
First Line	:	PO BOX 75629
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4755
Country	:	US
Telephone Number	:	440-777-6017
Fax Number	:	440-777-6940

Provider Business Practice Location Address
First Line	:	28 CONSERVATORY DR
Second Line	:	SUITE B
City	:	NORTON
State	:	OH
Zip	:	44203-4273
Country	:	US
Telephone Number	:	330-861-4100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID K. KEITH
Credential	:	D.O.
Telephone Number	:	330-861-4100

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	06/17/2008

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