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General NPI Number Information
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NPI Number | 1316968423
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Entity Type | Organization
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Legal Business Name | SEAN KEANE M.D. S.C.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2315 N LAKE DR SUITE 803
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City | MILWAUKEE
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State | WI
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Zip | 53211-4518
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Country | US
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Telephone | 414-277-1115
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Fax | 414-277-1126
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Provider Business Mailing Address
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Address Line | 2315 N LAKE DR SUITE 803
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City | MILWAUKEE
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State | WI
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Zip | 53211-4518
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Country | US
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Telephone | 414-277-1115
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Fax | 414-277-1126
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Authorized Official
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Title or Position | OWNER
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Name | SEAN KEANE
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Credential | M.D.
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Telephone | 414-277-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17123-020
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License Number State | WI
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