Provider Demographics
NPI:1346435898
Name:COVENTRY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:COVENTRY INTERNAL MEDICINE
Other - Org Name:MICHAEL E. KEENAN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-742-0807
Mailing Address - Street 1:1366 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-3168
Mailing Address - Country:US
Mailing Address - Phone:860-742-0807
Mailing Address - Fax:860-742-8702
Practice Address - Street 1:1366 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3168
Practice Address - Country:US
Practice Address - Phone:860-742-0807
Practice Address - Fax:860-742-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty