Provider Demographics
NPI:1811575467
Name:KEANE, SPENCER LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LAWRENCE
Last Name:KEANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 SOVEREIGN DR
Mailing Address - Street 2:
Mailing Address - City:SHARONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1772
Practice Address - Country:US
Practice Address - Phone:937-245-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001527213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery