MEDICARE: KEIVA L BLAND 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	208600000X	Surgery Physician	E-4903	AR
2	208600000X	Surgery Physician	35148075	OH
3	208600000X	Surgery Physician	4301076706	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00375089	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	06090017100	OTHER	AR	QUALCHOICE

General Provider Information

NPI Number	:	1467540732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIVA L BLAND MD

Provider Business Mailing Address
First Line	:	1 WILLIAM CARLS DR STE G-131
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2201
Country	:	US
Telephone Number	:	248-242-7330
Fax Number	:	248-242-5616

Provider Business Practice Location Address
First Line	:	1 WILLIAM CARLS DR # G-131
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2201
Country	:	US
Telephone Number	:	248-242-7330
Fax Number	:	248-242-5616

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	02/05/2026

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Practice Location Address:

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1689653669 — DR. JAY H KOZLOWSKI M.D., F.A.C.C.
Practice Location Address:

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Directions to “ KEIVA L BLAND MD” Practice Location

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