Provider Demographics
NPI:1073872859
Name:ARBUCKLE, KEITH (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:ARBUCKLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 N 79TH AVE STE F168
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6045
Mailing Address - Country:US
Mailing Address - Phone:602-675-0478
Mailing Address - Fax:602-675-0479
Practice Address - Street 1:13949 W MEEKER BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:602-675-0478
Practice Address - Fax:602-675-0479
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0836213E00000X
IL016005677213E00000X, 213ES0103X
AZPOD000836213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005677Medicaid
AZ161742Medicaid
ILF400229323Medicare PIN