Provider Demographics
NPI:1700968716
Name:KEEN, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KEEN
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:PO BOX 9030
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-9030
Mailing Address - Country:US
Mailing Address - Phone:847-495-1617
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:300 RANDALL RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-208-4009
Practice Address - Fax:630-208-0942
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036061087207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL930003733OtherRAILROAD MEDICARE
IL036061087 3Medicaid
IL036061087 3Medicaid
IL930003733OtherRAILROAD MEDICARE