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General NPI Number Information
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NPI Number | 1104356567
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Entity Type | Organization
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Legal Business Name | MMR CARDIOVASCULAR CONSULTING
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1101 GLENLAKE WAY
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City | LOUISVILLE
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State | KY
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Zip | 40245-5223
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Country | US
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Telephone | 812-491-1390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax | 812-473-5822
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Authorized Official
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Title or Position | OWNER
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Name | MATHEW CL KEITH
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Credential | MD, PHD
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Telephone | 318-393-2575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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