Provider Demographics
NPI:1427037878
Name:KEINATH, RUSSELL D (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:D
Last Name:KEINATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8632
Mailing Address - Country:US
Mailing Address - Phone:734-434-6262
Mailing Address - Fax:
Practice Address - Street 1:5300 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8632
Practice Address - Country:US
Practice Address - Phone:734-434-6262
Practice Address - Fax:734-712-2820
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043636207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H14989OtherBCBSM GROUP
MI4404030OtherAETNA
MI1728793Medicaid
MI2403058001OtherCIGNA
MI0H14989OtherBCBS GROUP
MI021534OtherMIDWEST HEALTH PLAN
MI4404030OtherAETNA
MI0M86720003Medicare PIN
MI1810851OtherBCBS INDIVIDUAL
MIF00385Medicare UPIN