Provider Demographics
NPI:1679569149
Name:KEILEY, MICHAEL V (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:KEILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1394
Mailing Address - Country:US
Mailing Address - Phone:208-378-0080
Mailing Address - Fax:208-378-0259
Practice Address - Street 1:901 N CURTIS RD
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1394
Practice Address - Country:US
Practice Address - Phone:208-378-0080
Practice Address - Fax:208-378-0259
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM7909207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1215061734Medicaid
ID1143164Medicare PIN
E60778Medicare UPIN