Provider Demographics
NPI:1568462729
Name:PITCHFORD, KEITH R (DO)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:R
Last Name:PITCHFORD
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 1:9615 KEILMAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-0220
Mailing Address - Fax:219-365-0226
Practice Address - Street 1:9615 KEILMAN STREET
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373
Practice Address - Country:US
Practice Address - Phone:219-365-0220
Practice Address - Fax:219-365-0226
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002102A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000232835OtherANTHEM
IN000000232835OtherANTHEM
IN215890AMedicare ID - Type Unspecified
ING12960Medicare UPIN