Healthcare Provider Details

I. General information

NPI: 1033541222
Provider Name (Legal Business Name): JAMES M. KEEGAN MD PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 5TH ST SUITE 1B
RAPID CITY SD
57701-6025
US

IV. Provider business mailing address

4940 5TH ST SUITE 1B
RAPID CITY SD
57701-6025
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-8329
  • Fax:
Mailing address:
  • Phone: 605-342-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number3381
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMES M KEEGAN
Title or Position: MD
Credential:
Phone: 605-342-8329