Provider Demographics
NPI:1497792352
Name:KEASHLY, RAE (MD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:KEASHLY
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 1:705 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1440
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2857
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2857
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0403067OtherMEDICA #
MN23Y87KEOtherMNBS #
MN23Y89KEOtherMNBS #
MN8050OtherSIOUX VALLEY #
MN0106730OtherMEDICA #
MN975817800Medicaid
MNMN100030OtherLHS/BANNERHEALTH #
MN0106547OtherMEDICA #
MN140791OtherUCARE #
MN18686Medicaid
MNDA9041015676OtherPREFERRED ONE #
MN904360OtherAMERICA'S PPO/ARAZ #
MNHP25788OtherHEALTHPARTNERS #
MN14173OtherNDBS #
MN23Y88KEOtherMNBS #
MN904360OtherAMERICA'S PPO/ARAZ #
MNHP25788OtherHEALTHPARTNERS #
MN080004649Medicare ID - Type UnspecifiedMN MEDICARE #
MN0403067OtherMEDICA #
MN18686Medicaid