Individual
KEITH BRUCE MCCOLLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
166 4TH ST E, SAINT PAUL, MN 55101-1421
(651) 292-2000
Mailing address
166 4TH ST E, SAINT PAUL, MN 55101-1421
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
10770
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427292796
—
MN
Enumeration date
04/29/2009
Last updated
11/12/2018
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