Keane, Mark R

Keane, Mark R is an sole proprietor health care provider with primary practice located at 415 6Th St , Lewiston ID 83501-2431. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Keane, Mark R can be contacted via phone (208) 750-7474.

Contact Information

Primary practice address
415 6Th St Lewiston ID 83501-2431
Phone: (208) 750-7474
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 24256 Arizona
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD00037909 Washington
Allopathic & Osteopathic Physicians / Neurology 2084N0400X M7728 Idaho

Profile Details

NPI number 1427044643
LBN Legal business name Keane, Mark R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 22nd, 2005
Last updated Apr 21st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427044643 NPPES
Idaho MEDICAID 805433500
Idaho MEDICAID 7088867
Idaho MEDICAID 8239543
Idaho Other 128039

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