MEDICARE: MITCHELL LOUIS KEEL MD

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
1	207R00000X	Internal Medicine Physician	MD2025-1294	NM
2	207R00000X	Internal Medicine Physician	E15275	AR

General Provider Information

NPI Number	:	1114480209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL LOUIS KEEL MD

Provider Business Mailing Address
First Line	:	PO BOX 844088
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4088
Country	:	US
Telephone Number	:	505-609-2258
Fax Number	:	505-609-2259

Provider Business Practice Location Address
First Line	:	407 S SCHWARTZ AVE STE 201
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5925
Country	:	US
Telephone Number	:	505-609-6730
Fax Number	:	505-599-4628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2019
Last Update Date	:	02/12/2026

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