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NPI Code Detail

MEDICARE: KEITH ROBERT UZPEN PA-S

MEDICARE: KEITH ROBERT UZPEN PA-S
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
12255A2300XAthletic Trainer
2363A00000XPhysician Assistant
3390200000XStudent in an Organized Health Care Education/Training ProgramMN

General Provider Information

NPI Number : 1851431852
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH ROBERT UZPEN PA-S
Provider Business Mailing Address
First Line : 3473 SAVANNAH AVE
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-4580
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 999-999-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 05/20/2024

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