Healthcare Provider Details

I. General information

NPI: 1578546180
Provider Name (Legal Business Name): KEITH E MCEWEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/27/2023
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST SUITE 340
NOBLESVILLE IN
46060-5005
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2500
  • Fax: 317-621-2503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01039385
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: