Provider Demographics
NPI:1487644803
Name:KEITEL, DUANE LESLIE (M D)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:LESLIE
Last Name:KEITEL
Suffix:
Gender:M
Credentials:M D
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 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:517 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-341-5030
Practice Address - Fax:859-578-7551
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.083505207K00000X
KY37692207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64067234Medicaid
KY0708303OtherMEDICARE PTAN
KY64067234Medicaid