Provider Demographics
NPI:1780698142
Name:NEWELL, KEITH J (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:NEWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1019 CAMPUS DRIVE
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-591-2614
Mailing Address - Fax:231-591-5970
Practice Address - Street 1:1019 CAMPUS DRIVE
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-591-2614
Practice Address - Fax:231-591-5970
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301040919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OE46000OtherBLUE CROSS
MIOE460000Medicare ID - Type Unspecified
B46355Medicare UPIN