Individual
DEANNA L PORTE KEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1650 45TH AVE, SUITE C, MUNSTER, IN 46321-3962
(219) 924-2444
(219) 924-2488
Mailing address
9660 WICKER AVENUE, ST JOHN, IN 46373-9487
(219) 924-2444
(219) 924-2488
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01029185
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000360206
ANTHEM BCBS
IN
01
—
351107009014
TRICARE
IN
01
—
P0029848
MEDICARE RAILROAD
IN
Enumeration date
08/22/2005
Last updated
06/21/2010
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