Provider Demographics
NPI:1528208840
Name:ANGELA KEEN MD P.L.L.C.
Entity Type:Organization
Organization Name:ANGELA KEEN MD P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-278-9062
Mailing Address - Street 1:6440 WASATCH BLVD
Mailing Address - Street 2:390
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3511
Mailing Address - Country:US
Mailing Address - Phone:801-278-9062
Mailing Address - Fax:801-272-0747
Practice Address - Street 1:6440 WASATCH BLVD
Practice Address - Street 2:390
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3511
Practice Address - Country:US
Practice Address - Phone:801-278-9062
Practice Address - Fax:801-272-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI12681Medicare UPIN