Provider Demographics
NPI:1235390402
Name:GERALD D KEYTE DO PC
Entity Type:Organization
Organization Name:GERALD D KEYTE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEYTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-721-2769
Mailing Address - Street 1:35324 COLLEGE
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-721-2769
Mailing Address - Fax:734-721-7839
Practice Address - Street 1:35324 COLLEGE
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-721-2769
Practice Address - Fax:734-721-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004817207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1035332Medicaid
MIE37535Medicare UPIN
MI1035332Medicaid