Individual
KEENAN GLEN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17705 HUTCHINS DR, MINNETONKA, MN 55345-4145
(952) 401-8300
Mailing address
17705 HUTCHINS DR STE 101, MINNETONKA, MN 55345-4102
(952) 401-8300
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
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