Provider Demographics
NPI:1568249928
Name:KEEDER, JULIA MAE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MAE
Last Name:KEEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 TOWNSHIP ROAD 203
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43910-7822
Mailing Address - Country:US
Mailing Address - Phone:740-317-0226
Mailing Address - Fax:
Practice Address - Street 1:340 OXFORD ST STE 200A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1965
Practice Address - Country:US
Practice Address - Phone:330-440-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034751207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine