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General NPI Number Information
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NPI Number | 1720306756
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Entity Type | Individual
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Provider Name | KEITH RAPHAEL DORAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 17300 WESTFIELD BLVD STE 110
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City | WESTFIELD
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State | IN
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Zip | 46074-1363
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Country | US
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Telephone | 317-763-1019
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Fax | 317-763-1082
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Provider Business Mailing Address
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Address Line | 12315 HANCOCK ST STE 24
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City | CARMEL
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State | IN
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Zip | 46032-5885
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Country | US
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Telephone | 317-708-3732
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Fax | 888-316-7962
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | G052927
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD067852L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | C1-0007713
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 01079816A
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License Number State | IN
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