Basic Information
| Provider Information | |||||||||
| NPI: | 1689663684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEEFE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1627 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805384209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706630135 | ||||||||
| FaxNumber: | 9704611422 | ||||||||
| Practice Location | |||||||||
| Address1: | 2923 GINNALA DR | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805382702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706696660 | ||||||||
| FaxNumber: | 9706691099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 02093 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 44297 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 77005848 | 05 | CO | MEDICAID | 2246934 | 05 | IA | MEDICAID |