Provider Demographics
NPI:1023030772
Name:KEELING, MARVIN R (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:R
Last Name:KEELING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-0126
Mailing Address - Country:US
Mailing Address - Phone:810-376-3100
Mailing Address - Fax:810-376-8311
Practice Address - Street 1:1484 STRAITS DR STE 5
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8718
Practice Address - Country:US
Practice Address - Phone:989-667-8740
Practice Address - Fax:989-667-8745
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK045279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00458078OtherRAILROAD MEDICARE
MI045279OtherSTATE LICENSE
MI5221962Medicaid
MIP00458078OtherRAILROAD MEDICARE
MIB45330Medicare UPIN