Healthcare Provider Details

I. General information

NPI: 1508285263
Provider Name (Legal Business Name): COREY KEETON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W GALBRAITH RD
CINCINNATI OH
45216-1015
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7700
  • Fax: 513-558-0877
Mailing address:
  • Phone: 513-245-3107
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.130433
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: