Provider Demographics
NPI:1053543090
Name:OKEEFE, COLLIN JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:JAMES
Last Name:OKEEFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 HAGGERTY RD STE 1110
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2185
Mailing Address - Country:US
Mailing Address - Phone:248-669-2000
Mailing Address - Fax:248-669-2110
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1110
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-669-2000
Practice Address - Fax:248-669-2110
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018246207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33953OtherBCBS
MI13516741OtherCAQH
MI0N95120Medicare PIN