Provider Demographics
NPI:1033954011
Name:RIGGS, KEEGAN
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:RIGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 DR MARTIN LUTHER KING JR ST UNIT 108
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3198
Mailing Address - Country:US
Mailing Address - Phone:630-632-4888
Mailing Address - Fax:
Practice Address - Street 1:1226 DR MARTIN LUTHER KING JR ST UNIT 108
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3198
Practice Address - Country:US
Practice Address - Phone:630-632-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program