Michael James Keberlein, MD
Individual provider Active NPI Internal Medicine Physician · Flagstaff, CA
NPI 1780655159 · NPPES record last updated Aug 22, 2014
Key facts
- NPI
- 1780655159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 12094 (AZ)
- Practice address
- 713 N Beaver St
Flagstaff, CA 86001-3142 - Phone
- (928) 779-7004
- Fax
- (928) 779-9123
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12094 | AZ | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flagstaff Medical Center | Past | Accepting new patients | |
| Ryan Internal Medicine PC | Internal Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CFIEAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 12094 | AZ | Yes |
| Cardiovascular Disease Physician | 207RC0000X | 12094 | AZ |
Addresses
Primary practice location
713 N Beaver St
Flagstaff, CA 86001-3142
Mailing address
713 N Beaver St
Flagstaff, AZ 86001-3142
Phone (928) 779-7004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0157550 | Other | AZ | BCBS AZ |
| 205452 | Medicaid | AZ |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.