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NPI Code Detail

MEDICARE: KEENAN GLEN RICHARDSON MD

MEDICARE: KEENAN GLEN RICHARDSON 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
1208000000XPediatrics Physician27968MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CP9040209014OTHERMNPREFERREDONE
2114509OTHERMNUCARE
3020K3RIOTHERMNBCBSOFMN
41200786OTHERMNMEDICA

General Provider Information

NPI Number : 1700858800
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEENAN GLEN RICHARDSON MD
Provider Business Mailing Address
First Line : 17705 HUTCHINS DR STE 101
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4102
Country : US
Telephone Number : 952-401-8300
Fax Number :
Provider Business Practice Location Address
First Line : 17705 HUTCHINS DR
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-4145
Country : US
Telephone Number : 952-401-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/09/2007

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Directions to “ KEENAN GLEN RICHARDSON MD” Practice Location

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