Provider Demographics
NPI:1689663684
Name:KEEFE, KEVIN WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:KEEFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:2923 GINNALA DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2702
Practice Address - Country:US
Practice Address - Phone:970-669-6660
Practice Address - Fax:970-669-1099
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02093207R00000X
CO44297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77005848Medicaid
IA2246934Medicaid
COP00399409Medicare PIN
COA03281Medicare UPIN
CO77005848Medicaid
IA07773Medicare ID - Type Unspecified