Provider Demographics
NPI:1013980234
Name:KEEFE, BETH G (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:G
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:600 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029
Practice Address - Country:US
Practice Address - Phone:262-369-7040
Practice Address - Fax:262-369-6922
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44488208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400384514OtherMEDICARE
WI1013980234Medicaid
WIW124700001Medicare PIN
WI34210500Medicaid