Richardson, Keenan Glen

Richardson, Keenan Glen is an individual health care provider with primary practice located at 17705 Hutchins Dr , Minnetonka MN 55345-4145. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Richardson, Keenan Glen can be contacted via phone (952) 401-8300.

Contact Information

Primary practice address
17705 Hutchins Dr Minnetonka MN 55345-4145
Phone: (952) 401-8300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 27968 Minnesota

Profile Details

NPI number 1700858800
LBN Legal business name Richardson, Keenan Glen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700858800 NPPES
Minnesota Other CP9040209014 PREFERREDONE
Minnesota Other 114509 PREFERREDONE
Minnesota Other 020K3RI PREFERREDONE
Minnesota Other 1200786 PREFERREDONE

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