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General NPI Number Information
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NPI Number | 1184667644
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Entity Type | Individual
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Provider Name | JACK K KEENE MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 11700 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-4656
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Country | US
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Telephone | 317-688-3140
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Fax | 317-688-2664
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE STE 130 PROVIDER ENROLLMENT
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01027792A
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License Number State | IN
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