Provider Demographics
NPI:1467540732
Name:BLAND, KEIVA L (MD)
Entity Type:Individual
Prefix:
First Name:KEIVA
Middle Name:L
Last Name:BLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12623 ECKEL JUNCTION RD STE 2600
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1304
Mailing Address - Country:US
Mailing Address - Phone:567-368-1490
Mailing Address - Fax:567-368-1478
Practice Address - Street 1:12623 ECKEL JUNCTION RD ST 2600
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1310
Practice Address - Country:US
Practice Address - Phone:567-368-1490
Practice Address - Fax:567-368-1478
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076706208600000X
ARE-4903208600000X
OH35148075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00375089OtherRAILROAD MEDICARE
AR163267001Medicaid
AR06090017100OtherQUALCHOICE
AR163267001Medicaid
ARP00375089OtherRAILROAD MEDICARE
MI0P30630552Medicare PIN