Provider Demographics
NPI:1265632483
Name:KEITH, COURTNEY A (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1950 CENTER CREEK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3428
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:507-238-1533
Practice Address - Street 1:1950 CENTER CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3428
Practice Address - Country:US
Practice Address - Phone:507-238-4968
Practice Address - Fax:507-238-1533
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN106477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine