Provider Demographics
NPI:1497720122
Name:KEIL, MICHAEL LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:KEIL
Suffix:
Gender:M
Credentials:DO
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 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-942-9424
Mailing Address - Fax:616-942-9797
Practice Address - Street 1:2757 LEONARD ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5807
Practice Address - Country:US
Practice Address - Phone:616-942-9424
Practice Address - Fax:616-942-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1854111145OtherBCBSM
MI4757986Medicaid
P19510001Medicare PIN
1854111145OtherBCBSM