Provider Demographics
NPI:1295855070
Name:KEETON, KRISTIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:LYNN
Last Name:KEETON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:4918 W CLARK RD STE 104
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1142
Practice Address - Country:US
Practice Address - Phone:734-528-9125
Practice Address - Fax:734-528-9263
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-08-05
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Provider Licenses
StateLicense IDTaxonomies
MI4301074290207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH89687Medicare UPIN