Provider Demographics
NPI:1821096629
Name:CHRISTMON, KEITH W (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:W
Last Name:CHRISTMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:585 SOUTH BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3163
Mailing Address - Country:US
Mailing Address - Phone:248-206-1200
Mailing Address - Fax:248-206-1206
Practice Address - Street 1:1627 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3501
Practice Address - Country:US
Practice Address - Phone:248-220-1560
Practice Address - Fax:248-220-1563
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKC067976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0806334351OtherBCBS BCN
MI080189691OtherRAILROAD MEDICARE
MI0806366101OtherBCN
MI4469855Medicaid
MI0806366101OtherBCBS
MI0N52570003Medicare PIN
MI080189691OtherRAILROAD MEDICARE