Provider Demographics
NPI:1710071576
Name:KEITH A. HORTON, M.D., P.A.
Entity Type:Organization
Organization Name:KEITH A. HORTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-920-2779
Mailing Address - Street 1:3131 EXCELSIOR BLVD
Mailing Address - Street 2:#306
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4600
Mailing Address - Country:US
Mailing Address - Phone:612-920-2779
Mailing Address - Fax:612-920-6957
Practice Address - Street 1:3131 EXCELSIOR BLVD
Practice Address - Street 2:#306
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4600
Practice Address - Country:US
Practice Address - Phone:612-920-2779
Practice Address - Fax:612-920-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN239832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB58592Medicare ID - Type Unspecified