Healthcare Provider Details

I. General information

NPI: 1104185503
Provider Name (Legal Business Name): BREANNA LYNN O'KEEFE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 CENTENNIAL WAY STE 300
LANSING MI
48917-8246
US

IV. Provider business mailing address

912 CENTENNIAL WAY STE 300
LANSING MI
48917-8246
US

V. Phone/Fax

Practice location:
  • Phone: 517-705-3910
  • Fax: 517-705-3911
Mailing address:
  • Phone: 517-705-3910
  • Fax: 517-705-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101019756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: