Healthcare Provider Details

I. General information

NPI: 1174723662
Provider Name (Legal Business Name): REEM KHEETAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ADAMS LN SUITE 600-700
PIKEVILLE KY
41501-3087
US

IV. Provider business mailing address

PO BOX 2917
PIKEVILLE KY
41502-2917
US

V. Phone/Fax

Practice location:
  • Phone: 606-218-3500
  • Fax:
Mailing address:
  • Phone: 606-218-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number45293
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: