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NPI Code Detail

MEDICARE: MARK PATRICK KEREKES MD

MEDICARE:   MARK PATRICK KEREKES  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
12084P0804XChild & Adolescent Psychiatry Physician39355MN

General Provider Information

NPI Number : 1215033238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PATRICK KEREKES MD
Provider Business Mailing Address
First Line : 2497 7TH AVE E
Second Line : SUITE 101 BHSI LLC
City : NORTH ST PAUL
State : MN
Zip : 55109-2496
Country : US
Telephone Number : 651-769-6200
Fax Number : 651-769-6249
Provider Business Practice Location Address
First Line : 1185 TOWN CENTRE DR
Second Line : SUITE 225 BHSI LLC
City : EAGAN
State : MN
Zip : 55123-1186
Country : US
Telephone Number : 651-769-6200
Fax Number : 651-769-6249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/08/2007

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