Provider Demographics
NPI:1043262876
Name:MCKEEN, STEPHANIE GILLETTE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GILLETTE
Last Name:MCKEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:36105 LEHINGER RD
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-4413
Mailing Address - Country:US
Mailing Address - Phone:218-743-3369
Mailing Address - Fax:
Practice Address - Street 1:36105 LEHINGER RD
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628-4413
Practice Address - Country:US
Practice Address - Phone:218-743-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine