Healthcare Provider Details

I. General information

NPI: 1750532107
Provider Name (Legal Business Name): HARRY LEE KEFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15238 CHARBONO ST
FISHERS IN
46037-7332
US

IV. Provider business mailing address

15238 CHARBONO ST
FISHERS IN
46037-7332
US

V. Phone/Fax

Practice location:
  • Phone: 317-674-4001
  • Fax:
Mailing address:
  • Phone: 317-674-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01220244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: