Provider Demographics
NPI:1265424675
Name:PORTE KEENE, DEANNA L (MD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:PORTE KEENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LYNNE SPORKE
Other - Last Name:PORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9660 WICKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-924-2444
Mailing Address - Fax:219-924-2488
Practice Address - Street 1:1650 45TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3962
Practice Address - Country:US
Practice Address - Phone:219-924-2444
Practice Address - Fax:219-924-2488
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000360206OtherANTHEM BCBS
IN351107009014OtherTRICARE
INP0029848OtherMEDICARE RAILROAD
IN000000360206OtherANTHEM BCBS
IN351107009014OtherTRICARE