Provider Demographics
NPI:1558813410
Name:DR. PAUL J KEANE
Entity Type:Organization
Organization Name:DR. PAUL J KEANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:704-289-3338
Mailing Address - Street 1:506 S SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5061
Mailing Address - Country:US
Mailing Address - Phone:704-289-3338
Mailing Address - Fax:
Practice Address - Street 1:506 S SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5061
Practice Address - Country:US
Practice Address - Phone:704-289-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty