Keith Wesley Ivens, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301085294 Issued in MI

Practice address

3496 E Lake Lansing Rd
Suite 100
East Lansing, MI 48823-2288

Phone

(517) 333-0968

Fax

(517) 333-4280

NPI assigned

Feb 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932240421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3496 E LAKE LANSING RD",
            "address_2": "SUITE 100",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488232288",
            "telephone_number": "517-333-0968",
            "fax_number": "517-333-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3496 E LAKE LANSING RD",
            "address_2": "SUITE 100",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488232288",
            "telephone_number": "517-333-0968",
            "fax_number": "517-333-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVENS",
        "first_name": "KEITH",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301085294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Surgery Physician in Michigan

• 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.

Verify at the official NPI Registry.