Healthcare Provider Details

I. General information

NPI: 1891767372
Provider Name (Legal Business Name): KEITH C BARKOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 PARKWAY AVE
ELKHART IN
46516-9334
US

IV. Provider business mailing address

226 US HIGHWAY 20
MIDDLEBURY IN
46540-9713
US

V. Phone/Fax

Practice location:
  • Phone: 574-537-0521
  • Fax: 574-537-1217
Mailing address:
  • Phone: 574-825-8068
  • Fax: 574-825-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01048887A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: