Provider Demographics
NPI:1619056587
Name:KEIM, DEANNE J (DPM)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:J
Last Name:KEIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:JEANETTE
Other - Last Name:KEIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:S68W15500 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-2613
Mailing Address - Country:US
Mailing Address - Phone:414-422-2180
Mailing Address - Fax:
Practice Address - Street 1:S68W15500 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-2613
Practice Address - Country:US
Practice Address - Phone:414-422-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI845-025213E00000X
IL16-004958213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02120-0130Medicare PIN
WI68015-0004Medicare PIN