Healthcare Provider Details

I. General information

NPI: 1346433935
Provider Name (Legal Business Name): JAIME MCKEEVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11590 N MERIDIAN ST SUITE 170
CARMEL IN
46032
US

IV. Provider business mailing address

11590 N MERIDIAN ST SUITE 170
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-3040
  • Fax: 317-848-5380
Mailing address:
  • Phone: 317-848-3040
  • Fax: 317-848-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11012046A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064405A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: