Provider Demographics
NPI:1043261639
Name:KEIT, JOAN I (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:I
Last Name:KEIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:IOVIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3807
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0807
Mailing Address - Country:US
Mailing Address - Phone:402-572-2265
Mailing Address - Fax:402-572-2031
Practice Address - Street 1:3764 39TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4564
Practice Address - Country:US
Practice Address - Phone:402-562-8666
Practice Address - Fax:402-562-8426
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE212422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F80479Medicare UPIN
NE279948Medicare PIN