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General NPI Number Information
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NPI Number | 1467454009
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Entity Type | Individual
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Provider Name | KEITH BELLOVICH DO
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 18001 E 10 MILE RD SUITE 1
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City | ROSEVILLE
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State | MI
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Zip | 48066-3803
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Country | US
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Telephone | 586-218-5800
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Fax | 586-218-5808
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Provider Business Mailing Address
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Address Line | 45640 SCHOENHERR RD SUITE B
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-6033
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Country | US
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Telephone | 586-247-4300
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Fax | 586-532-6496
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | KB010619
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 48692
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License Number State | CO
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