Provider Demographics
NPI:1831322965
Name:KEYES, CORPIA CHANTLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORPIA
Middle Name:CHANTLE
Last Name:KEYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORPIA
Other - Middle Name:CHANTLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 ILLINOIS ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1867
Mailing Address - Country:US
Mailing Address - Phone:312-608-9917
Mailing Address - Fax:312-488-3637
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:STE 100A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:866-375-3937
Practice Address - Fax:312-488-3637
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.056055207R00000X
IN01072345A207R00000X
IL036-129521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036129521Medicaid
IL0727500006Medicare NSC
IL390361Medicare PIN