MEDICARE: DR. MICHAEL STEPHEN KEEL D.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	1223G0001X	General Practice Dentistry	198082	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64066152	OTHER	MS	EIN

General Provider Information

NPI Number	:	1437247939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEPHEN KEEL D.M.D.

Provider Business Mailing Address
First Line	:	20040 PINEVILLE RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3352
Country	:	US
Telephone Number	:	228-868-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	20040 PINEVILLE RD
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-3352
Country	:	US
Telephone Number	:	228-868-2828
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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