Provider Demographics
NPI:1356451942
Name:MOODY, KEITH J (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:MOODY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:10850 E TRAVERSE HWY
Mailing Address - Street 2:STE 4400
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1364
Mailing Address - Country:US
Mailing Address - Phone:231-346-6800
Mailing Address - Fax:989-340-1214
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-340-1211
Practice Address - Fax:989-340-1214
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-11-19
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Provider Licenses
StateLicense IDTaxonomies
MI5101008328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1150900464OtherHEALTH PLUS OF MI
MI1006214OtherMCLAREN HEALTH PLAN
MI1150900464OtherFEP
MI1006214OtherMCLAREN HEALTH ADVANTAGE
MI4164290Medicaid
MI110197522OtherUNITED HEALTHCARE
MI16613OtherCOMMUNITY CHOICE
MI28233OtherPRIORITY HEALTH
MI4220040OtherAETNA
MI50900464OtherBLUE CARE NETWORK
MI1150900464OtherBCBSM
MI28233OtherPRIORITY HEALTH
MI4164290Medicaid