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Individual

DR. CHARLES M KEOLEIAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1040 DELAWARE AVE, MARION, OH 43302-6416
(740) 383-7950
(740) 375-8164
Mailing address
5450 FRANTZ RD STE 360, DUBLIN, OH 43016-4141
(614) 544-6370

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35.140177
OH
208800000X
Urology Physician
4301054366
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10534
MCARE
MI
01
133384
PREFERRED AND CARE CHOICE
MI
01
340019725
RAILROAD MEDICARE
MI
01
340634410-1
BCBSM INDIVIDUAL ID
MI
05
4387203
MI
05
4973505
MI
01
5281117
AETNA
MI
01
CK054366
BCBSM IDENTIFIER
MI
01
G14839
HAP
MI
Enumeration date
11/30/2005
Last updated
07/17/2020
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