Richardson, Keenan Glen
Richardson, Keenan Glen is an individual health care provider with primary practice located at 17705 Hutchins Dr , Minnetonka MN 55345-4145. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Richardson, Keenan Glen can be contacted via phone (952) 401-8300.Contact Information
Primary practice address
17705 Hutchins Dr
Minnetonka MN 55345-4145
Phone: (952) 401-8300
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 27968 | Minnesota |
Profile Details
| NPI number | 1700858800 |
|---|---|
| LBN Legal business name | Richardson, Keenan Glen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 2nd, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700858800 | NPPES |
| Minnesota | Other | CP9040209014 | PREFERREDONE |
| Minnesota | Other | 114509 | PREFERREDONE |
| Minnesota | Other | 020K3RI | PREFERREDONE |
| Minnesota | Other | 1200786 | PREFERREDONE |
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