=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700992484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH L PAPENDICK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 09/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21215 N ULDRIKS DR
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49017-9008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-274-8994
-----------------------------------------------------
Fax | 314-919-8933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21215 N ULDRIKS DR
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49017-9008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-274-8994
-----------------------------------------------------
Fax | 314-919-8933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301060967
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------