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General NPI Number Information
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NPI Number | 1356325674
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Entity Type | Individual
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Provider Name | CHARLES M KEOLEIAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 1040 DELAWARE AVE
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City | MARION
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State | OH
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Zip | 43302-6416
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Country | US
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Telephone | 740-383-7950
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Fax | 740-375-8164
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Provider Business Mailing Address
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Address Line | 5450 FRANTZ RD STE 360
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City | DUBLIN
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State | OH
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Zip | 43016-4141
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Country | US
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Telephone |
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Fax | 614-544-6370
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301054366
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35.140177
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License Number State | OH
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