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General NPI Number Information
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NPI Number | 1982149787
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT KEANE I L.AC., B.PH
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Gender | Male
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 8151 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2902
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Country | US
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Telephone | 215-487-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 316 STANCHION DR
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City | STROUDSBURG
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State | PA
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Zip | 18360-8318
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Country | US
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Telephone | 570-234-6216
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AK001190
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License Number State | PA
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