Provider Demographics
NPI:1063491231
Name:KEEL, AMANDA EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:KEEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:EILEEN
Other - Last Name:MOHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 N CURTIS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1337
Mailing Address - Country:US
Mailing Address - Phone:208-377-3435
Mailing Address - Fax:208-377-3147
Practice Address - Street 1:1000 N CURTIS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1337
Practice Address - Country:US
Practice Address - Phone:208-377-3435
Practice Address - Fax:208-377-3147
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45799208100000X
NE23709208100000X
IA37126208100000X
IDM-12757208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1574095Medicaid
NE47037661525Medicaid
H89833Medicare UPIN
NE47037661525Medicaid
NE47037661525Medicaid
MN250000596Medicare ID - Type Unspecified