Provider Demographics
NPI:1326571308
Name:KEEFE, RANDI JEAN (DPM)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:JEAN
Last Name:KEEFE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3449
Mailing Address - Country:US
Mailing Address - Phone:440-352-2201
Mailing Address - Fax:
Practice Address - Street 1:161 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3449
Practice Address - Country:US
Practice Address - Phone:440-352-2201
Practice Address - Fax:440-352-0242
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003959213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program