Provider Demographics
NPI:1003078452
Name:KEELA YOUNT, INC.
Entity Type:Organization
Organization Name:KEELA YOUNT, INC.
Other - Org Name:MID-MICHIGAN PEDORTHIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:517-351-2688
Mailing Address - Street 1:4500 S HAGADORN RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6813
Mailing Address - Country:US
Mailing Address - Phone:517-351-2688
Mailing Address - Fax:517-351-4770
Practice Address - Street 1:4500 S HAGADORN RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6813
Practice Address - Country:US
Practice Address - Phone:517-351-2688
Practice Address - Fax:517-351-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C313020OtherBLUE CROSS/BLUE SHIELD
MI540C313020OtherBLUE CROSS/BLUE SHIELD