Healthcare Provider Details

I. General information

NPI: 1073715447
Provider Name (Legal Business Name): DAVID K. KEITH DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CONSERVATORY DR SUITE B
BARBERTON OH
44203-4275
US

IV. Provider business mailing address

28 CONSERVATORY DR SUITE B
BARBERTON OH
44203-4275
US

V. Phone/Fax

Practice location:
  • Phone: 330-861-4100
  • Fax: 330-861-0987
Mailing address:
  • Phone: 330-861-4100
  • Fax: 330-861-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-007169
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID KEVIN KEITH
Title or Position: OWNER
Credential: D.O
Phone: 330-861-4100