Provider Demographics
NPI:1871500371
Name:SANNEMAN, KEITH D (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
Last Name:SANNEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:D
Other - Last Name:SANNEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:520 N ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1951
Mailing Address - Country:US
Mailing Address - Phone:818-843-3600
Mailing Address - Fax:818-843-0527
Practice Address - Street 1:520 N ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1951
Practice Address - Country:US
Practice Address - Phone:818-843-3600
Practice Address - Fax:818-843-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2015213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11774059OtherCAQH
CA000E20150OtherMEDI-CAL
CA1871500371OtherMEDICARE NPI
CAE2015OtherPTAN
CAP00892868OtherMEDICARE RAILROAD
CAP00892868OtherMEDICARE RAILROAD
CAP00892868OtherMEDICARE RAILROAD