Healthcare Provider Details

I. General information

NPI: 1093773996
Provider Name (Legal Business Name): LINDSAY K KEYES D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 W LINCOLN RD
KOKOMO IN
46902-3590
US

IV. Provider business mailing address

1791 W LINCOLN RD
KOKOMO IN
46902-3590
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-7600
  • Fax: 765-453-3861
Mailing address:
  • Phone: 765-453-7600
  • Fax: 765-453-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-005242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: