Individual
MR. CHARLES R. MCKEEN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 W 1ST ST, BLOOMINGTON, IN 47403-2403
(812) 332-3531
(812) 332-4673
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-2154
(812) 353-5228
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01030763A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100183460
—
IN
Enumeration date
10/16/2006
Last updated
12/18/2020
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