Provider Demographics
NPI:1316383391
Name:KEYES, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 SOUTH JACKSON STREET
Mailing Address - Street 2:AMBULATORY CARE BUILDING, 2ND FLOOR, DEPT OF SURGERY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:502-852-6880
Mailing Address - Fax:502-852-8915
Practice Address - Street 1:550 SOUTH JACKSON STREET
Practice Address - Street 2:AMBULATORY CARE BUILDING, 2ND FLOOR, DEPT OF SURGERY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-852-6880
Practice Address - Fax:502-852-8915
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY52127208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100598000Medicaid