Basic Information
| Provider Information | |||||||||
| NPI: | 1346435898 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COVENTRY INTERNAL MEDICINE | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MICHAEL E. KEENAN, M.D. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1366 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COVENTRY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062383168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607420807 | ||||||||
| FaxNumber: | 8607428702 | ||||||||
| Practice Location | |||||||||
| Address1: | 1366 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COVENTRY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062383168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607420807 | ||||||||
| FaxNumber: | 8607428702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 09/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | KEENAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8607420807 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 026639 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.