Provider Demographics
NPI:1629839147
Name:ANGELA KEON MD LLC
Entity Type:Organization
Organization Name:ANGELA KEON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-205-8755
Mailing Address - Street 1:100 MADRID BLVD UNIT 311
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7906
Mailing Address - Country:US
Mailing Address - Phone:941-205-8755
Mailing Address - Fax:941-205-8762
Practice Address - Street 1:100 MADRID BLVD UNIT 311
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7906
Practice Address - Country:US
Practice Address - Phone:941-205-8755
Practice Address - Fax:941-205-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty