Provider Demographics
NPI:1043275571
Name:KEITH, RACHEL R (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:KEITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:STE 102
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3301
Mailing Address - Fax:608-935-3823
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:STE 102
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:608-935-3823
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI46056-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043275571Medicaid
WI1043275571Medicaid
WIK400176495Medicare PIN
WI006957155Medicare PIN
WI60424OtherDEAN HEALTH INSURANCE
I42110Medicare UPIN