Basic Information
| Provider Information | |||||||||
| NPI: | 1902880743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEATING | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1199 HADLEY RD | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461581788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178312273 | ||||||||
| FaxNumber: | 3178319347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1199 HADLEY RD | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461581788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178312273 | ||||||||
| FaxNumber: | 3178319347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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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 | 207X00000X | 01034994 | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200040493 | 01 | IN | RR MEDICARE | OTHER | 1078189 | 01 | IN | UHC | OTHER | 006736 | 01 | IN | SIHO | OTHER | 000000188525 | 01 | IN | BCBS | OTHER | 4355530 | 01 | IN | AETNA | OTHER |