Provider Demographics
NPI:1083611560
Name:TOBIN, KEITH M (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:TOBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28701 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2335
Mailing Address - Country:US
Mailing Address - Phone:734-427-9900
Mailing Address - Fax:734-427-8963
Practice Address - Street 1:28701 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2335
Practice Address - Country:US
Practice Address - Phone:734-427-9900
Practice Address - Fax:734-427-8963
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010694207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4082200Medicaid
MI5101010694OtherSTATE LICENSE NUMBER
MI5820442OtherBCBS PROVIDER ID
MI993699OtherAETNA PROVIDER ID
MIF05096OtherHAP PROVIDER ID
MIC4002OtherMCARE PROVIDER ID
MIP86747OtherBCN PROVIDER ID
MIP86747OtherBCN PROVIDER ID
MIC4002OtherMCARE PROVIDER ID