MEDICARE: KEITH E MCEWEN JR. 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
1	208600000X	Surgery Physician	01039385	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01405435	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000089044	OTHER	IN	BLUE CROSS BLUE SHIELD
2	000000781468	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2235832	OTHER	IN	AETNA
6	I014043	OTHER	IN	CHAMPUS

General Provider Information

NPI Number	:	1578546180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH E MCEWEN JR. MD

Provider Business Mailing Address
First Line	:	8081 RAVEN ROCK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8081 RAVEN ROCK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1854
Country	:	US
Telephone Number	:	317-915-1058
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	02/18/2026

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Directions to “ KEITH E MCEWEN JR. MD” Practice Location

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