Provider Demographics
NPI:1376518134
Name:KEENE, MICHAEL GRAHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRAHAM
Last Name:KEENE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SPRINGFIELD COMMONS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8533
Mailing Address - Country:US
Mailing Address - Phone:919-876-3656
Mailing Address - Fax:919-876-2351
Practice Address - Street 1:800 SPRINGFIELD COMMONS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8533
Practice Address - Country:US
Practice Address - Phone:919-876-3656
Practice Address - Fax:919-876-2351
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2758222Medicare ID - Type Unspecified
P86377Medicare UPIN