Healthcare Provider Details

I. General information

NPI: 1659909224
Provider Name (Legal Business Name): KEATON DUBOIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 N MERIDIAN ST
CARMEL IN
46290-1028
US

IV. Provider business mailing address

800 ROSE STREET ANESTHESIOLOGY
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 317-583-5000
  • Fax:
Mailing address:
  • Phone: 859-218-0069
  • Fax: 859-323-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02008343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: