Individual
KEENAN R BERGHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01063361A
IN
208600000X
Surgery Physician
Primary
115623
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000607167
ANTHEM
IN
05
—
200855420
—
IN
Enumeration date
06/06/2006
Last updated
02/18/2021
Update your record
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