DR. KEITH Y MIYAMOTO (NPI# 1609883842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609883842 |
| Entity Type | Individual |
| Full Name | DR. KEITH Y MIYAMOTO |
| Credential | M.D. |
| Practice Address |
829 N Center Ave Suite 160 Gaylord MI 49735-1595 |
| Mailing Address |
829 N Center Ave Suite 298 Gaylord MI 49735-1595 |
| Practice Telephone | 9897317131 |
| Practice Fax Number | 9897316415 |
| Mailing Telephone | 9897317708 |
| Mailing Fax Number | 9897317929 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-12-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 4301032171 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE GROUP NUMBER | OF96004 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194814152 | Keith S Miyamoto | Pediatrics | 15725 E Whittier Blvd, Whittier, CA 90603-2347 | 2006-10-11 |
| Street Address |
829 N CENTER AVE SUITE 160 |
| City | GAYLORD |
| State | MI |
| Zip Code | 49735-1595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598754715 | Luis Raul Collazo | Pediatrics | 829 N Center Ave, Suite 130, Gaylord, MI 49735-1595 | 2005-10-20 |
| 1174043889 | Michael D Katona | Nurse Practitioner | 829 N Center Ave, Gaylord, MI 49735-1595 | 2017-06-23 |
| 1114303575 | Brittanie Hamlin | Physician Assistant | 829 N Center Ave, Gaylord, MI 49735-1595 | 2015-08-07 |
| 1326443722 | Coleman Gulick | Nurse Practitioner | 829 N Center Ave, Gaylord, MI 49735-1595 | 2014-10-28 |
| 1720417694 | Kristy J. Alexander | Nurse Practitioner | 829 N Center Ave, Suite 200, Gaylord, MI 49735-1595 | 2013-11-01 |
| 1235401712 | John Matthew Lawrence | Physician Assistant | 829 N Center Ave, Suite 210, Gaylord, MI 49735-1595 | 2012-01-31 |
| 1043505399 | Yelena V Isayenko | Family Medicine | 829 N Center Ave, Suite 210, Gaylord, MI 49735-1595 | 2011-06-15 |
| 1598073801 | Shawn M Bahleda | Physician Assistant | 829 N Center Ave, Gaylord, MI 49735-1595 | 2010-09-21 |
| 1942511126 | Amanda Lee Williams | Pediatrics | 829 N Center Ave, Suite 130, Gaylord, MI 49735-1595 | 2010-06-23 |
| 1639301724 | Ronald Frank Applebey | Physician Assistant | 829 N Center Ave, Suite 210, Gaylord, MI 49735-1595 | 2009-08-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447453 | Jenni Kirt | Social Worker | 407 I-75 Bus N, Gaylord, MI 49735 | 2020-11-05 |
| 1922584986 | Patricia Dovalina | Behavior Technician | 2285 Michaywe Dr, Otsego Lake, MI 49735 | 2018-07-12 |
| 1265944581 | James Hulbert | Social Worker | 407 W Main Street, Gaylord, MI 49735 | 2017-10-26 |
| 1548792625 | Somer Lawes | Behavior Technician | 2443 Castlewood Dr, Gaylord, MI 49735 | 2017-03-29 |
| 1922554161 | Mark David Mcpherson | Counselor | 2136 West M-32, Gaylord, MI 49735 | 2016-08-28 |
| 1689063034 | Liza Brandt | Behavioral Analyst | 6748 Colonial Ct, Gaylord, MI 49735 | 2015-01-22 |
| 1942597224 | Visions for Your Community Care Hhc | Home Health | 2365 N Perch Lake Dr, Gaylord, MI 49735 | 2011-07-07 |
| 1073778304 | Julie Lynn Vandusen | Community Health Worker | 5512 Clubhouse Trail, Gaylord, MI 49735 | 2008-07-25 |
| 1073708798 | Alpine Chiropractic, PC | Chiropractor | 529 S. Wisconsin Ave, Gaylord, MI 49735 | 2007-09-06 |
| 1669675567 | Oral and Maxillofacial Surgery Associates | Dentist | 785 E M32, Gaylord, MI 49735 | 2007-06-07 |
| Find all providers in zip 49735 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427064054 | Munson Healthcare Otsego Memorial Hospital | Urology | 829 N Center Ave, Suite 160, Gaylord, MI 49735 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477488 | Munson Healthcare Charlevoix Hospital | Urology | 11695 Park Ave, Suite A, Charlevoix, MI 49720 | 2020-11-06 |
| 1396235610 | Munson Medical Center | Urology | 405 N Division Rd Ste 2, Petoskey, MI 49770-9046 | 2018-05-11 |
| 1770072498 | Bellin Health Iron Mountain Inc | Urology | 1005 S Hemlock St Ste B, Iron Mountain, MI 49801-3854 | 2018-05-08 |
| 1205215621 | Alexander David Tapper | Urology | 44200 Woodward Ave Ste 207, Pontiac, MI 48341-5045 | 2015-05-19 |
| 1912324211 | Boston Medical Group, P.C. | Urology | 24901 Northwestern Hwy., Suite 615, Southfield, MI 48075 | 2014-03-25 |
| 1548600984 | Katie Marie Rosen | Urology | 19991 Hall Rd Ste 201, Macomb, MI 48044 | 2013-06-30 |
| 1609213636 | Arya Khatiwoda | Urology | 2900 Hannah Blvd Ste 104, East Lansing, MI 48823-5380 | 2013-05-31 |
| 1003179730 | Kalen Jacob Rimar | Urology | 130 Town Center Dr Ste 101, Troy, MI 48084 | 2012-06-18 |
| 1780955294 | Harry Nicholas Kotsis | Urology | 265 Touraine Rd, Grosse Pointe Farms, MI 48236-3308 | 2012-01-16 |
| 1750678264 | Michael Kozminski | Urology | 245 Cherry St Se Ste 202, Grand Rapids, MI 49503-4607 | 2011-07-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.