Healthcare Provider Details

I. General information

NPI: 1982668315
Provider Name (Legal Business Name): JODI MICHELE KEFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S 5TH ST
PHILADELPHIA PA
19147-5919
US

IV. Provider business mailing address

1400 S 5TH ST
PHILADELPHIA PA
19147-5919
US

V. Phone/Fax

Practice location:
  • Phone: 215-467-3515
  • Fax: 215-467-0338
Mailing address:
  • Phone: 215-467-3515
  • Fax: 215-467-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD062494-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: