Provider Demographics
NPI:1487670881
Name:KEEN, ANGELA M (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:KEEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:370 9TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2877
Mailing Address - Country:US
Mailing Address - Phone:801-364-3613
Mailing Address - Fax:801-322-1099
Practice Address - Street 1:370 9TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2877
Practice Address - Country:US
Practice Address - Phone:801-364-3613
Practice Address - Fax:801-322-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3288331205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery