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NPI Code Detail

MEDICARE: DR. MARK R KEANE M.D.

MEDICARE: DR. MARK R KEANE 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
12084N0400XNeurology PhysicianMD00037909WA
22084N0400XNeurology Physician24256AZ
32084N0400XNeurology PhysicianM7728ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2128039OTHERWAL & I WA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427044643
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK R KEANE M.D.
Provider Business Mailing Address
First Line : 415 6TH STREET
Second Line :
City : LEWISTON
State : ID
Zip : 83501-2424
Country : US
Telephone Number : 208-750-7462
Fax Number : 208-750-7467
Provider Business Practice Location Address
First Line : 415 6TH ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-2431
Country : US
Telephone Number : 208-750-7474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 12/26/2024

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