Provider Demographics
NPI:1669462404
Name:MINIHANE, KEITH P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:MINIHANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 PHAY AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2302
Mailing Address - Country:US
Mailing Address - Phone:719-285-2646
Mailing Address - Fax:719-285-2647
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2302
Practice Address - Country:US
Practice Address - Phone:719-285-2646
Practice Address - Fax:719-285-2647
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109086207X00000X
CO46332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery