Healthcare Provider Details

I. General information

NPI: 1497720122
Provider Name (Legal Business Name): MICHAEL LOUIS KEIL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 LEONARD ST NE SUITE 300
GRAND RAPIDS MI
49525-5807
US

IV. Provider business mailing address

PO BOX 3140
GRAND RAPIDS MI
49501-3140
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-9424
  • Fax: 616-942-9797
Mailing address:
  • Phone: 616-942-9424
  • Fax: 616-942-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101012052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: