Provider Demographics
NPI:1295718062
Name:HARVEY, KEITH A (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 HIGH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2361
Mailing Address - Country:US
Mailing Address - Phone:260-724-8551
Mailing Address - Fax:260-728-3858
Practice Address - Street 1:955 HIGH ST
Practice Address - Street 2:STE 1
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2361
Practice Address - Country:US
Practice Address - Phone:260-724-8551
Practice Address - Fax:260-728-3858
Is Sole Proprietor?:No
Enumeration Date:2005-11-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046376A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000385181OtherANTHEM
IN200162270Medicaid
IN000000385181OtherANTHEM
ING53618Medicare UPIN