=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982608410
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL J KEANE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2005
-----------------------------------------------------
Last Update Date | 08/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 MAIN ST
-----------------------------------------------------
City | COOPERS MILLS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04341-3758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-549-7581
-----------------------------------------------------
Fax | 937-847-8635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 727
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-3758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-495-3323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 36002572
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------