Healthcare Provider Details

I. General information

NPI: 1184812471
Provider Name (Legal Business Name): BRIAN M KEUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22285 N PEPPER RD #201
LAKE BARRINGTON IL
60010-2538
US

IV. Provider business mailing address

22285 N PEPPER RD #201
LAKE BARRINGTON IL
60010-2538
US

V. Phone/Fax

Practice location:
  • Phone: 847-382-5080
  • Fax:
Mailing address:
  • Phone: 847-382-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD036518
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: