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General NPI Number Information
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NPI Number | 1811087323
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Entity Type | Individual
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Provider Name | ANTHONY A KILLEEN MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 420 DELAWARE STREET SE 760 MAYO MEMORIAL BUILDING
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-625-5443
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Fax | 612-625-1121
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Provider Business Mailing Address
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Address Line | 420 DELAWARE ST SE MMC 609 UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-625-5443
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Fax | 612-625-1121
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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 | 207ZP0007X
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Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
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License Number | 30034
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207ZP0104X
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Taxonomy Name | Chemical Pathology Physician
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License Number | 30034
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 30034
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License Number State | MN
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