Healthcare Provider Details

I. General information

NPI: 1992772289
Provider Name (Legal Business Name): DAVID LOUIS KEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14160 JAMESTOWN RD
BREESE IL
62230-3694
US

IV. Provider business mailing address

14160 JAMESTOWN RD
BREESE IL
62230-3694
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7154
  • Fax:
Mailing address:
  • Phone: 618-526-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000768
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-004886
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: