Provider Demographics
NPI:1164415659
Name:ATKINSON, KEITH V (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:V
Last Name:ATKINSON
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 1:6889 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1658
Mailing Address - Country:US
Mailing Address - Phone:248-666-5200
Mailing Address - Fax:248-666-5200
Practice Address - Street 1:6889 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1658
Practice Address - Country:US
Practice Address - Phone:248-666-5200
Practice Address - Fax:248-666-5200
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKA012524207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5630659OtherBCBSM
MIH05020OtherHEALTH ALLIANCE PLAN
MI0F31072OtherBCBSM COMMON PROV ID #
MI4602937Medicaid
MIC8023OtherM-CARE
MI127722OtherCARE CHOICES
MI4175696Medicaid
MIH05020Medicare UPIN
MI4602937Medicaid
MI0P44710Medicare PIN