Basic Information
| Provider Information | |||||||||
| NPI: | 1780686485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OH | ||||||||
| FirstName: | KEAN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39650 ORCHARD HILL PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483755391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483190161 | ||||||||
| FaxNumber: | 2483190170 | ||||||||
| Practice Location | |||||||||
| Address1: | 860 EAST FRONT STREET | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496862704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319380710 | ||||||||
| FaxNumber: | 2319380264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4301091262 | MI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 4301091262 | MI | Y |
No ID Information.