Basic Information
Provider Information | |||||||||
NPI: | 1871780676 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEESHIN | ||||||||
FirstName: | SUSAN | ||||||||
MiddleName: | WILLIAMS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WILLIAMS | ||||||||
OtherFirstName: | SUSAN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2830 VICTORY PKWY | ||||||||
Address2: | CENTRAL CREDENTIALING | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452061785 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5132453669 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 231 ALBERT SABIN WAY | ||||||||
Address2: | HOLMES BUILDING | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452672827 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5134756868 | ||||||||
FaxNumber: | 5135846386 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2007 | ||||||||
LastUpdateDate: | 01/03/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/03/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 63605381205 | UT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 2080P0208X | 6360538-1205 | UT | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
No ID Information.