Provider Demographics
NPI:1578584926
Name:BARBOUR, KEITH ROYDON (DO)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ROYDON
Last Name:BARBOUR
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 1:905 N MACOMB ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3076
Mailing Address - Country:US
Mailing Address - Phone:734-241-0560
Mailing Address - Fax:734-241-3230
Practice Address - Street 1:905 N MACOMB ST STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3076
Practice Address - Country:US
Practice Address - Phone:734-241-0560
Practice Address - Fax:734-241-3230
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008796208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1906616Medicaid
MI1906616Medicaid