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NPI Code Detail

MEDICARE: DR. MELISSA KEENE M.D.

MEDICARE: DR. MELISSA KEENE 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
1207V00000XObstetrics & Gynecology Physician125058596IL

General Provider Information

NPI Number : 1902117047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA KEENE M.D.
Provider Business Mailing Address
First Line : 2801 LAKESIDE DR STE 209
Second Line :
City : BANNOCKBURN
State : IL
Zip : 60015-1271
Country : US
Telephone Number : 847-562-1410
Fax Number : 847-562-0830
Provider Business Practice Location Address
First Line : 1000 CENTRAL ST STE 700
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1769
Country : US
Telephone Number : 847-869-3300
Fax Number : 847-869-1303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2010
Last Update Date : 01/24/2020

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Directions to “ DR. MELISSA KEENE M.D.” Practice Location

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