Provider Demographics
NPI:1134653520
Name:KECK, IAN RANDALL (DO)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:RANDALL
Last Name:KECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-04-20
Deactivation Date:2019-06-18
Deactivation Code:
Reactivation Date:2019-06-21
Provider Licenses
StateLicense IDTaxonomies
HIDOS-2295207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine