Active NPI
Phadej Keopunna, MD
- Urology Physician
- Saginaw, MI
National Provider Identifier
1699873075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- PK035585
- Practice address
- 70 North Frost Dr
Saginaw, MI 48638 - Phone
- (989) 792-6776
- Fax
- (989) 792-6792
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | PK035585 | MI | Primary |
Addresses
Primary practice location
70 North Frost Dr
Saginaw, MI 48638
Mailing address
70 North Frost Drive
Saginaw, MI 48638
Phone (989) 792-6776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2105487 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PK035585 | MI | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699873075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 NORTH FROST DRIVE",
"city": "SAGINAW",
"state": "MI",
"postal_code": "48638",
"telephone_number": "989-792-6776",
"fax_number": "989-792-6792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 NORTH FROST DR",
"city": "SAGINAW",
"state": "MI",
"postal_code": "48638",
"telephone_number": "989-792-6776",
"fax_number": "989-792-6792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOPUNNA",
"first_name": "PHADEJ",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MI",
"license": "PK035585",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2105487",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.