Healthcare Provider Details

I. General information

NPI: 1760509293
Provider Name (Legal Business Name): STEPHEN A KEI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 EAST ST
PLAINVILLE CT
06062-2935
US

IV. Provider business mailing address

240 EAST ST
PLAINVILLE CT
06062-2935
US

V. Phone/Fax

Practice location:
  • Phone: 860-747-4541
  • Fax: 860-793-1218
Mailing address:
  • Phone: 860-747-4541
  • Fax: 860-793-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number027429
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number027429
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: