Provider Demographics
NPI:1700992484
Name:PAPENDICK, KEITH L (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:L
Last Name:PAPENDICK
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 1:21215 N ULDRIKS DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9008
Mailing Address - Country:US
Mailing Address - Phone:269-274-8994
Mailing Address - Fax:314-919-8933
Practice Address - Street 1:21215 N ULDRIKS DR
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-9008
Practice Address - Country:US
Practice Address - Phone:269-274-8994
Practice Address - Fax:314-919-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4227970Medicaid
F52689Medicare UPIN
MI4227970Medicaid
0M99190Medicare PIN