Provider Demographics
NPI:1578546180
Name:MCEWEN, KEITH E JR (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:MCEWEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9669 E 146TH ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5005
Practice Address - Country:US
Practice Address - Phone:317-621-2500
Practice Address - Fax:317-621-2503
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039385208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089044OtherBLUE CROSS BLUE SHIELD
IN000000781468OtherANTHEM
IN100177090AMedicaid
IN2235832OtherAETNA
INP01405435OtherRR MEDICARE
INI014043OtherCHAMPUS
IN000000089044OtherBLUE CROSS BLUE SHIELD
INI014043OtherCHAMPUS