Healthcare Provider Details

I. General information

NPI: 1699737494
Provider Name (Legal Business Name): PETER PHILIP MCKEOWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W 5TH ST STE 303
LONDON KY
40741-1688
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 606-862-9280
  • Fax: 859-862-9290
Mailing address:
  • Phone: 859-313-2758
  • Fax: 859-276-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2005-01855
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2005-01855
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2005-01855
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number41559
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: