Individual
KEENAN GLEN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
27968
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020K3RI
BCBSOFMN
MN
01
—
114509
UCARE
MN
01
—
1200786
MEDICA
MN
01
—
CP9040209014
PREFERREDONE
MN
Enumeration date
02/02/2006
Last updated
07/09/2007
Update your record
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