Individual
DR. KEEGAN LAWRENCE MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2351 CONNECTICUT AVE S, SUITE 200, SARTELL, MN 56377-2477
(320) 259-1411
(320) 259-8967
Mailing address
401 9TH AVE NW, WATERTOWN, SD 57201-1548
(605) 882-7777
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
12655
SD
208800000X
Urology Physician
51197
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790712883
—
MN
01
—
P00629856
RAILROAD MEDICARE
MN
Enumeration date
06/26/2006
Last updated
07/08/2021
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