Healthcare Provider Details

I. General information

NPI: 1083160527
Provider Name (Legal Business Name): CHRISTOPHER KEEMER LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 BALDWIN AVE STE 400
PONTIAC MI
48340-1242
US

IV. Provider business mailing address

159 CHEROKEE RD
PONTIAC MI
48341-2000
US

V. Phone/Fax

Practice location:
  • Phone: 313-978-4118
  • Fax:
Mailing address:
  • Phone: 313-978-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008331
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: