Provider Demographics
NPI:1659578052
Name:KEETON, KEVIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:KEETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 HERITAGE WAY
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3158
Mailing Address - Country:US
Mailing Address - Phone:406-257-8992
Mailing Address - Fax:406-755-4161
Practice Address - Street 1:350 HERITAGE WAY
Practice Address - Street 2:SUITE 2100
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3158
Practice Address - Country:US
Practice Address - Phone:406-257-8992
Practice Address - Fax:406-755-4161
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20385207R00000X, 207RP1001X, 208000000X
MT20027207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06386869Medicaid
MS06386869Medicaid