Healthcare Provider Details

I. General information

NPI: 1720050057
Provider Name (Legal Business Name): MARC S KEYS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 E MICHIGAN AVE
JACKSON MI
49201-2401
US

IV. Provider business mailing address

823 E MICHIGAN AVE
JACKSON MI
49201-2401
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-7760
  • Fax: 517-788-7730
Mailing address:
  • Phone: 517-788-7760
  • Fax: 517-788-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMK000761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: