Healthcare Provider Details

I. General information

NPI: 1073517744
Provider Name (Legal Business Name): KEITH T HUFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 STE 1100
AVON IN
46123-9627
US

IV. Provider business mailing address

PO BOX 314
FRANKLIN IN
46131-0314
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7500
  • Fax: 317-272-7515
Mailing address:
  • Phone: 317-346-6176
  • Fax: 317-736-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01028609A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01028609A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01028609A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: