MEDICARE: BRET THOMAS KEAN 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	207X00000X	Orthopaedic Surgery Physician	6611350-1205	UT

General Provider Information

NPI Number	:	1871797654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRET THOMAS KEAN MD

Provider Business Mailing Address
First Line	:	6542 SE LAKE RD
Second Line	:	SUITE 201
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-1769
Fax Number	:	503-659-7522

Provider Business Practice Location Address
First Line	:	6542 SE LAKE RD
Second Line	:	SUITE 201
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-1769
Fax Number	:	503-659-7522

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	11/11/2010

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