Healthcare Provider Details

I. General information

NPI: 1861402802
Provider Name (Legal Business Name): KEITH L CURTIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 204
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 204
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-1041
  • Fax: 313-240-7093
Mailing address:
  • Phone: 313-593-1041
  • Fax: 313-240-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301025238
License Number StateMI

VIII. Authorized Official

Name: KEITH L CURTIS
Title or Position: MANAGING AGENT/OWNER
Credential: MD
Phone: 313-593-1041