Provider Demographics
NPI:1851362966
Name:KEEN, MARC ELWIN (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ELWIN
Last Name:KEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-0306
Mailing Address - Country:US
Mailing Address - Phone:231-845-2362
Mailing Address - Fax:231-845-2440
Practice Address - Street 1:1 N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2362
Practice Address - Fax:231-845-2440
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057451207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2773078Medicaid
MI2205330071OtherBCBS
MI2205330071OtherBCBS
MID94855Medicare UPIN