Individual
DR. KEITH Y MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
829 N CENTER AVE, SUITE 160, GAYLORD, MI 49735-1595
(989) 731-7131
(989) 731-6415
Mailing address
829 N CENTER AVE, SUITE 298, GAYLORD, MI 49735-1595
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301032171
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OF96004
MEDICARE GROUP NUMBER
—
Enumeration date
08/01/2006
Last updated
12/23/2020
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