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NPI Code Detail

MEDICARE: SYRIL KEENA QUE M.D.

MEDICARE: SYRIL KEENA QUE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207ND0101XMOHS-Micrographic Surgery Physician01081348AIN

General Provider Information

NPI Number : 1053672014
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYRIL KEENA QUE M.D.
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10300 N ILLINOIS ST
Second Line :
City : CARMEL
State : IN
Zip : 46290-1166
Country : US
Telephone Number : 317-948-5928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 01/22/2021

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Directions to “ SYRIL KEENA QUE M.D.” Practice Location

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