Provider Demographics
NPI:1295798908
Name:SUMEY, KEITH D (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:SUMEY
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 1:1858 FIRCREST DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2139
Mailing Address - Country:US
Mailing Address - Phone:616-881-9555
Mailing Address - Fax:616-881-9555
Practice Address - Street 1:1858 FIRCREST DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2139
Practice Address - Country:US
Practice Address - Phone:616-881-9555
Practice Address - Fax:616-881-9555
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078906207P00000X, 207PE0004X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00824253OtherRAILROAD MEDICARE
MID16094146Medicare PIN