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NPI Code Detail

MEDICARE: JOHN R KEENER MD

MEDICARE: JOHN R KEENER 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
1207Q00000XFamily Medicine Physician25488WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160687OTHERWIDEAN HEALTH INSURANCE

General Provider Information

NPI Number : 1578539086
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R KEENER MD
Provider Business Mailing Address
First Line : 3200 E RACINE ST
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-2343
Country : US
Telephone Number : 608-371-8000
Fax Number : 608-371-8938
Provider Business Practice Location Address
First Line : 3200 E RACINE ST
Second Line :
City : JANESVILLE
State : WI
Zip : 53546-2343
Country : US
Telephone Number : 608-371-8000
Fax Number : 608-371-8938
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 05/16/2014

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