Provider Demographics
NPI:1821046566
Name:GURIN, TERESA LOUISE-KELLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LOUISE-KELLER
Last Name:GURIN
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 1:4660 SLATER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4047
Mailing Address - Country:US
Mailing Address - Phone:952-223-3339
Mailing Address - Fax:952-314-1401
Practice Address - Street 1:4660 SLATER RD STE 240
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:952-223-3339
Practice Address - Fax:952-314-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39052208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG44349Medicare UPIN