Provider Demographics
NPI:1780686485
Name:OH, KEAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KEAN
Middle Name:T
Last Name:OH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:39650 ORCHARD HILL PL STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5391
Mailing Address - Country:US
Mailing Address - Phone:248-319-0161
Mailing Address - Fax:248-319-0170
Practice Address - Street 1:860 EAST FRONT STREET
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2704
Practice Address - Country:US
Practice Address - Phone:231-938-0710
Practice Address - Fax:231-938-0264
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
MI4301091262207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780686485Medicaid
MI0M21980024Medicare PIN
G88105Medicare UPIN