Healthcare Provider Details

I. General information

NPI: 1649726548
Provider Name (Legal Business Name): MEGAN KEEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 CAREW ST STE 300
FORT WAYNE IN
46805-4764
US

IV. Provider business mailing address

2200 RANDALLIA DR
FORT WAYNE IN
46805-4638
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-6650
  • Fax:
Mailing address:
  • Phone: 260-373-7765
  • Fax:

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: