Healthcare Provider Details

I. General information

NPI: 1316909831
Provider Name (Legal Business Name): CHRISTOPHER WILLIAM KEANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 80116
CITY OF INDUSTRY CA
91716-8116
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5111
  • Fax: 405-749-4561
Mailing address:
  • Phone: 800-749-4560
  • Fax: 405-749-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01094959A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036172081
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA86553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: