Myles David Keroack
Internist Gastroenterologist
2116 Craig Rd
Eau Claire
, Wisconsin 54701-6149
Myles David Keroack
Internist Gastroenterologist
2116 Craig Rd
Eau Claire
, Wisconsin 54701-6149
(715) 387-5511
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About
Features
Specialties
- Internist
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Myles David Keroack
- 1000 N Oak Ave
- Marshfield, WI
- Zip : 54449-5703
- Phone : (715) 387-5511
Second Address
- Myles David Keroack
- 2116 Craig Rd
- Eau Claire, WI
- Zip : 54701-6149
- Phone : (715) 858-4500
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Is Myles David Keroack a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | 72672 | MA |
| N | 111NI0900X | Internist | 72672 | MA |
| Y | 207RG0100X | Gastroenterologist | 55795 | WI |
| N | 207RG0100X | Gastroenterologist | 72672 | MA |
National Provider Identifier
| NPI | 1013998582 |
|---|---|
| Provider Name | Myles David Keroack |
| First Address | Marshfield, WI 54449-5703 |
| Second Address | Eau Claire, WI 54701-6149 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/11/2005 |
| Last Update Date | 06/07/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 072672 | TUFTS HEALTH PLAN (01) | MA |
| 3088898 | (05) | MA |
| E71797 | (02) | |
| J10606 | BCBS MA (01) | MA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.