Individual
KEITH D HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON ST, MC 11102F, ST PAUL, MN 55101-2502
(651) 254-3456
(651) 254-5216
Mailing address
8100 34TH AVE S, MC21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7172
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
47419
MN
207P00000X
Emergency Medicine Physician
51157
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051027100
—
MN
Enumeration date
02/17/2006
Last updated
08/18/2022
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