Healthcare Provider Details

I. General information

NPI: 1407048036
Provider Name (Legal Business Name): CHARLES R. MCKEEN, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W 1ST ST
BLOOMINGTON IN
47403-2403
US

IV. Provider business mailing address

413 W 1ST ST
BLOOMINGTON IN
47403-2403
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-3531
  • Fax: 812-332-4673
Mailing address:
  • Phone: 812-332-3531
  • Fax: 812-332-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES R MCKEEN
Title or Position: M.D.
Credential:
Phone: 812-332-3531