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General NPI Number Information
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NPI Number | 1215101696
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Entity Type | Individual
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Provider Name | MICHELLE ANNE KEISKI PHD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 12/06/2014
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Provider Practice Location Address
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Address Line | 355 W 16TH ST STE 4700
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2285
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Country | US
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Telephone | 317-963-7514
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Fax |
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Provider Business Mailing Address
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Address Line | 6848 REUNION LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-3921
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Country | US
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Telephone | 317-956-4025
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 20042607A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY8059
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License Number State | FL
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