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General NPI Number Information
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NPI Number | 1932335668
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Entity Type | Individual
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Provider Name | MICHAEL KEEDY CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 101 S MAJOR ST
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City | EUREKA
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State | IL
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Zip | 61530-1246
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Country | US
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Telephone | 309-304-2004
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Fax | 309-467-2880
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Provider Business Mailing Address
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Address Line | 101 S MAJOR ST
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City | EUREKA
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State | IL
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Zip | 61530-1246
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Country | US
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Telephone | 309-304-2004
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Fax | 309-467-2880
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209007640
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 041-343146
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License Number State | IL
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