Provider Demographics
NPI:1578194866
Name:KETO CONSULTS LLC
Entity Type:Organization
Organization Name:KETO CONSULTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARISSE
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-272-6521
Mailing Address - Street 1:7469 E BROADWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1487
Mailing Address - Country:US
Mailing Address - Phone:520-771-9288
Mailing Address - Fax:
Practice Address - Street 1:7469 E BROADWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1487
Practice Address - Country:US
Practice Address - Phone:520-771-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty