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General NPI Number Information
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NPI Number | 1285912402
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Entity Type | Individual
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Provider Name | THOMAS D KEENAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 1 S PARK ST, 7TH FLOOR DEPARTMENT OF DERMATOLOGY,UNIVERSITY OF WISCONSIN
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City | MADISON
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State | WI
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Zip | 53715-0001
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Country | US
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Telephone | 608-287-2620
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Fax | 608-287-2676
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Provider Business Mailing Address
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Address Line | 1 S PARK ST, 7TH FLOOR DEPARTMENT OF DERMATOLOGY,UNIVERSITY OF WISCONSIN
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City | MADISON
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State | WI
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Zip | 53715-0001
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Country | US
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Telephone | 608-287-2620
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 61274
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License Number State | WI
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