Provider Demographics
NPI:1437136678
Name:KEELEY, MICHAEL MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MURRAY
Last Name:KEELEY
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3825
Practice Address - Country:US
Practice Address - Phone:980-487-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437136678Medicaid
SCN34222Medicaid
47983OtherBCBS
741493OtherUHC
560943383COtherCIGNA
291789OtherMAMSI
4541385OtherAETNA
160021405OtherRAILROAD MEDICARE
NC7947983Medicaid
2036104OtherAETNA US HEALTH
BK3577410OtherDEA
47719OtherMEDCOST
NC1437136678Medicaid
291789OtherMAMSI
NC7947983Medicaid
NC2191119Medicare PIN