Healthcare Provider Details

I. General information

NPI: 1902873391
Provider Name (Legal Business Name): CURTIS LEE KELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 ROBINSON DR NW
COON RAPIDS MN
55433-3746
US

IV. Provider business mailing address

8100 34TH AVE S 21110Q
BLOOMINGTON MN
55425-1672
US

V. Phone/Fax

Practice location:
  • Phone: 763-712-6000
  • Fax: 763-754-4614
Mailing address:
  • Phone: 952-883-5790
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number33398
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: