Provider Demographics
NPI:1417357906
Name:KEEGAN, MICHAEL SEAN (MC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SEAN
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5134
Mailing Address - Country:US
Mailing Address - Phone:623-326-4681
Mailing Address - Fax:
Practice Address - Street 1:730 W 3RD ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5134
Practice Address - Country:US
Practice Address - Phone:623-326-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2727101YP2500X
AZLPC14194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027081700Medicaid