Individual
AMY JANE KEENUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO, PHARMD
Contact information
Practice address
804 SERVICE RD, A235, EAST LANSING, MI 48824-7015
(517) 355-1300
(517) 355-1710
Mailing address
804 SERVICE RD, A235, EAST LANSING, MI 48824-7015
(517) 355-1300
(517) 355-1710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101011498
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-41688
UNITED HEALTH CARE
TN
01
—
080164595
RAILROAD MEDICARE
—
01
—
100032496
PHP TENNCARE
TN
05
—
1154388734
—
MI
01
—
3159480
BLUE CROSS/BLUE SHIELD
TN
05
—
3306480
—
TN
01
—
5954498
AETNA
TN
01
—
9206416
CIGNA
TN
01
—
TN01G4
JOHN DEERE
TN
Enumeration date
04/27/2006
Last updated
09/05/2018
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