Provider Demographics
NPI:1619975513
Name:KEHOE, ELLEN L (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:L
Last Name:KEHOE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 S CRAPO ST
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2961
Mailing Address - Country:US
Mailing Address - Phone:989-817-3412
Mailing Address - Fax:989-953-4186
Practice Address - Street 1:211 S CRAPO ST
Practice Address - Street 2:STE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2961
Practice Address - Country:US
Practice Address - Phone:989-953-4186
Practice Address - Fax:989-953-4186
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008190207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3268093Medicaid
MIOC36345019Medicare ID - Type Unspecified
MI3268093Medicaid