Healthcare Provider Details

I. General information

NPI: 1447252028
Provider Name (Legal Business Name): JOSHUA W KEYES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 W LINCOLN ROAD
KOKOMO IN
46092-3274
US

IV. Provider business mailing address

3731 GUION ROAD SUITE C
INDIANAPOLIS IN
46222-7604
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-7600
  • Fax: 765-453-3861
Mailing address:
  • Phone: 317-931-0664
  • Fax: 317-927-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001003A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: