MEDICARE: ANGELA KEEN MD P.L.L.C.

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1528208840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA KEEN MD P.L.L.C.

Provider Business Mailing Address
First Line	:	6440 WASATCH BLVD
Second Line	:	390
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3511
Country	:	US
Telephone Number	:	801-278-9062
Fax Number	:	801-272-0747

Provider Business Practice Location Address
First Line	:	6440 WASATCH BLVD
Second Line	:	390
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3511
Country	:	US
Telephone Number	:	801-278-9062
Fax Number	:	801-272-0747

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ANGELA M KEEN
Credential	:	MD
Telephone Number	:	801-278-9062

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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