Healthcare Provider Details

I. General information

NPI: 1285869081
Provider Name (Legal Business Name): DR. KEITH DOUGLAS SCHULHOF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4959 EXCELSIOR BLVD STE 200
SAINT LOUIS PARK MN
55416-3003
US

IV. Provider business mailing address

4959 EXCELSIOR BLVD STE 200
SAINT LOUIS PARK MN
55416-3003
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-8774
  • Fax:
Mailing address:
  • Phone: 952-920-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13648
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: