Martin, Keith R

Martin, Keith R is an individual health care provider with primary practice located at 3103 W Kunkle Blvd , Freeport IL 61032-6922. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine, which is considered as his primary health care specialty. Martin, Keith R can be contacted via phone (815) 233-0999.

Contact Information

Primary practice address
3103 W Kunkle Blvd Freeport IL 61032-6922
Phone: (815) 233-0999
Fax: (815) 233-7255
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207VH0002X Illinois

Profile Details

NPI number 1801007190
LBN Legal business name Martin, Keith R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801007190 NPPES
Illinois Other 08932003 BLUE CROSS BLUE SHIELD OF

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