Provider Demographics
NPI:1649478538
Name:KEIBLER, MATTHEW THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:KEIBLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STATE ROUTE 159 STE 270
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7502
Mailing Address - Country:US
Mailing Address - Phone:740-779-4550
Mailing Address - Fax:740-779-4569
Practice Address - Street 1:4439 STATE ROUTE 159 STE 270
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7502
Practice Address - Country:US
Practice Address - Phone:740-779-4550
Practice Address - Fax:740-779-4569
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017294208600000X
OH34.016155208600000X
TN2391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM35150175OtherMEDICARE
TN1529536Medicaid
MI1649478538Medicaid