Healthcare Provider Details

I. General information

NPI: 1982608410
Provider Name (Legal Business Name): DANIEL J KEANE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/27/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAIN ST
COOPERS MILLS ME
04341-3758
US

IV. Provider business mailing address

PO BOX 727
WATERVILLE ME
04901-3758
US

V. Phone/Fax

Practice location:
  • Phone: 207-549-7581
  • Fax: 937-847-8635
Mailing address:
  • Phone: 207-495-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36002572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: