Provider Demographics
NPI:1164438743
Name:KEEP, MARCUS F (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:F
Last Name:KEEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1802
Practice Address - Country:US
Practice Address - Phone:701-234-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020410207T00000X
PAMD423288207T00000X
ND8573207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56132832OtherMEDICAID GROUP NUMBER
CO83151559Medicaid
CO36132832OtherMEDICAID PRACTICE NUMBER
CO70259526OtherMEDICAID PRACTICE NUMBER
CO348308OtherMEDICARE GROUP PTAN NUMBE
PA1023760700001Medicaid
COC810213OtherMEDICARE GROUP NUMBER
COC810213OtherMEDICARE GROUP NUMBER
CO36132832OtherMEDICAID PRACTICE NUMBER
PA165867Medicare PIN
CO808554Medicare PIN