Provider Demographics
NPI:1215033238
Name:KEREKES, MARK PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:KEREKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:SUITE 101 BHSI LLC
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6200
Mailing Address - Fax:651-769-6249
Practice Address - Street 1:1185 TOWN CENTRE DR
Practice Address - Street 2:SUITE 225 BHSI LLC
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1186
Practice Address - Country:US
Practice Address - Phone:651-769-6200
Practice Address - Fax:651-769-6249
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN393552084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G09697Medicare UPIN