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Individual

MARK K KEOHANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9323 PHOENIX VILLAGE PKWY, O FALLON, MO 63366-4281
(636) 561-5030
(636) 561-5033
Mailing address
9323 PHOENIX VILLAGE PKWY, O FALLON, MO 63366-4281
(636) 561-5030
(636) 561-5033

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
34653
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
122683
HEALTHLINK
01
18883
BLUE CROSS BLUE SHIELD
01
2253V3458
GHP/ADVANTRA
01
351240001
CIGNA DMERC
01
4061116
AETNA
01
43177
CMR
01
4434V6097
HEALTHCARE USA
01
900094
UHC
01
9043
EXCLUSIVE CHOICE
01
SP10133
CIGNA
Enumeration date
05/23/2005
Last updated
03/01/2012
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