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NPI Code Detail

MEDICARE: MR. RONALD DOUGLAS KEEN II ATC

MEDICARE:  MR. RONALD DOUGLAS KEEN II ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1477580066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD DOUGLAS KEEN II ATC
Provider Business Mailing Address
First Line : 11910 ANDERSONVILLE RD
Second Line :
City : DAVISBURG
State : MI
Zip : 48350-3027
Country : US
Telephone Number : 248-980-4484
Fax Number :
Provider Business Practice Location Address
First Line : 800 W AVON RD
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-2704
Country : US
Telephone Number : 248-218-2148
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/08/2007

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Directions to “ MR. RONALD DOUGLAS KEEN II ATC” Practice Location

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