MEDICARE: DR. LARRY ALLEN KEYES DPM

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	213ES0131X	Foot Surgery Podiatrist		IL

General Provider Information

NPI Number	:	1720118367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY ALLEN KEYES DPM

Provider Business Mailing Address
First Line	:	1758 N NATOMA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3916
Country	:	US
Telephone Number	:	773-237-5968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 MADISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4404
Country	:	US
Telephone Number	:	708-771-4300
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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