Whitesides, Keith Randall

Whitesides, Keith Randall is an individual health care provider with primary practice located at 2800 Ferry St , Lafayette IN 47904-3022. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Whitesides, Keith Randall can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
2800 Ferry St Lafayette IN 47904-3022
Phone: (765) 448-8000
Fax: (765) 447-9749
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01032200A Indiana

Profile Details

NPI number 1548229644
LBN Legal business name Whitesides, Keith Randall
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2006
Last updated Jul 23rd, 2012 - about 13 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 1548229644 NPPES
Indiana Other 431714 PHCS PID NUMBER
Indiana Other 000000190237 PHCS PID NUMBER
Indiana Other 10826183 PHCS PID NUMBER
Indiana MEDICAID 200100480 PHCS PID NUMBER

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