Provider Demographics
NPI:1487687166
Name:DEFEVER, KEITH S (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:S
Last Name:DEFEVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34301 23 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4432
Mailing Address - Country:US
Mailing Address - Phone:586-725-1770
Mailing Address - Fax:586-725-4080
Practice Address - Street 1:34301 23 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4432
Practice Address - Country:US
Practice Address - Phone:586-725-1770
Practice Address - Fax:586-725-4080
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1977449Medicaid
MI1977449Medicaid
MI0N58330Medicare PIN