Provider Demographics
NPI:1245273515
Name:CAMANN, KEITH ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALBERT
Last Name:CAMANN
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 1:463 EAST CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1037
Mailing Address - Country:US
Mailing Address - Phone:517-884-6546
Mailing Address - Fax:
Practice Address - Street 1:463 EAST CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1037
Practice Address - Country:US
Practice Address - Phone:517-884-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4739683Medicaid
MI1245273515Medicaid
MIC36019122Medicare PIN
MIB46130Medicare UPIN
MI4739683Medicaid