Provider Demographics
NPI:1326095241
Name:KEHOE, JAMES L IV (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:KEHOE
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:21510 HARRINGTON ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2362
Mailing Address - Country:US
Mailing Address - Phone:586-627-1100
Mailing Address - Fax:586-627-1120
Practice Address - Street 1:21550 HARRINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-2362
Practice Address - Country:US
Practice Address - Phone:586-627-1100
Practice Address - Fax:586-627-1120
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-10-04
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Provider Licenses
StateLicense IDTaxonomies
MIJK012581207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383423447OtherTAX ID
G80160Medicare UPIN