MEDICARE: ALLEN KEITH WESLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	40525	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144276783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN KEITH WESLEY MD

Provider Business Mailing Address
First Line	:	E2965 BENRUD LN
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-8581
Country	:	US
Telephone Number	:	715-878-9741
Fax Number	:	715-878-4675

Provider Business Practice Location Address
First Line	:	799 REANEY AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4412
Country	:	US
Telephone Number	:	651-232-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	05/16/2019

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Directions to “ ALLEN KEITH WESLEY MD” Practice Location

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