Provider Demographics
NPI:1023118619
Name:KEEGAN, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 5TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6025
Mailing Address - Country:US
Mailing Address - Phone:605-342-8329
Mailing Address - Fax:
Practice Address - Street 1:4940 5TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6025
Practice Address - Country:US
Practice Address - Phone:605-342-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3381207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994439OtherWELLMARK
SD9172878OtherDAKOTACARE
SDP00261629OtherRR MEDICARE
SD6002254Medicaid
SDP00261629OtherRR MEDICARE
SD9172878OtherDAKOTACARE