Healthcare Provider Details

I. General information

NPI: 1669815445
Provider Name (Legal Business Name): ANTHONY PETER MCKEEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S UNION AVE STE 100
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

2883 KENT RD
SILVER LAKE OH
44224-3741
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6500
  • Fax:
Mailing address:
  • Phone: 330-620-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.012872
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: