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General NPI Number Information
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NPI Number | 1235515545
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Entity Type | Individual
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Provider Name | MR. KEITH MURBACH
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Gender | Male
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 206-348-8206
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Fax |
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Provider Business Mailing Address
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Address Line | 635 E GOLF RD
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3439
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60598599
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7313-33
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209013034
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License Number State | IL
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