Provider Demographics
NPI:1265431241
Name:KEAMY, MITCHELL FADOUL III (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:FADOUL
Last Name:KEAMY
Suffix:III
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 1:3157 N RAINBOW BLVD # 518
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-877-8661
Mailing Address - Fax:702-877-5140
Practice Address - Street 1:2850 S MOJAVE RD LOT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-386-4700
Practice Address - Fax:702-386-4701
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5653207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504191Medicaid
NVP0169392OtherRAILROAD MEDICARE
C96214Medicare UPIN
NV100504191Medicaid