Provider Demographics
NPI:1174578116
Name:KEATING, E CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:E
Middle Name:CHRISTINE
Last Name:KEATING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:#1020
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4537
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-2937
Practice Address - Street 1:3201 S 16TH STREET
Practice Address - Street 2:SUITE #1020
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-643-7337
Practice Address - Fax:414-643-1766
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI24155 WI208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32424700Medicaid
G63287Medicare UPIN