MEDICARE: KELLY ANN KEENER

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1750654695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN KEENER

Provider Business Mailing Address
First Line	:	3950 BEAUBIEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2166
Country	:	US
Telephone Number	:	313-832-9262
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 BEAUBIEN BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201
Country	:	US
Telephone Number	:	313-832-9262
Fax Number	:

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

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	04/20/2026

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Directions to “ KELLY ANN KEENER ” Practice Location

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