Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101017526 | MI |
NPI | 1164619169 |
---|---|
Provider Name | Kent Keele |
First Address | Kalispell, MT 59901-3102 |
Second Address | Kalispell, MT 59901-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 09/04/2014 |