Provider Demographics
NPI:1063488724
Name:LITKEY, JOANN CECILIA KEITH (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:CECILIA KEITH
Last Name:LITKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 3RD ST
Mailing Address - Street 2:ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1950
Mailing Address - Country:US
Mailing Address - Phone:218-786-4000
Mailing Address - Fax:
Practice Address - Street 1:265 GRIFFIN ST E
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1439
Practice Address - Country:US
Practice Address - Phone:715-268-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56627-20207P00000X
MN48299207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1063488724Medicaid
WI1063488724Medicaid
WI1063488724Medicaid