Healthcare Provider Details

I. General information

NPI: 1700968716
Provider Name (Legal Business Name): JAMES KEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RANDALL RD EMERGENCY DEPT
GENEVA IL
60134-4200
US

IV. Provider business mailing address

PO BOX 9030
WHEELING IL
60090-9030
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-4009
  • Fax: 630-208-0942
Mailing address:
  • Phone: 847-495-1617
  • Fax: 847-537-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036061087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: