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1427037878

NPI Code Detail

MEDICARE: RUSSELL D KEINATH M.D.

MEDICARE: RUSSELL D KEINATH 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
1	207RG0100X	Gastroenterology Physician	4301043636	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H14989	OTHER	MI	BCBSM GROUP
2	4404030	OTHER	MI	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2403058001	OTHER	MI	CIGNA
5	0H14989	OTHER	MI	BCBS GROUP
6	021534	OTHER	MI	MIDWEST HEALTH PLAN

General Provider Information

NPI Number	:	1427037878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL D KEINATH M.D.

Provider Business Mailing Address
First Line	:	5300 ELLIOTT DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-8632
Country	:	US
Telephone Number	:	734-434-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 ELLIOTT DR
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-8632
Country	:	US
Telephone Number	:	734-434-6262
Fax Number	:	734-712-2820

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	01/12/2018

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Directions to “ RUSSELL D KEINATH M.D.” Practice Location

Language	Start Address	Practice Location

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