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Individual

DR. JACK K KEENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11700 N MERIDIAN ST, CARMEL, IN 46032-4656
(317) 688-3140
(317) 688-2664
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01027792A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100378870
IN
Enumeration date
06/13/2006
Last updated
02/06/2014
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