Provider Demographics
NPI:1972692895
Name:KEENAN, PATRICK A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-302-8200
Mailing Address - Fax:
Practice Address - Street 1:1020 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-02704OtherMEDICA-CHOICE
MN060889OtherFAIRVIEW
MN01-02704OtherMEDICA-PRIMARY
MN58D73KEOtherBCBS
768190OtherARAZ
MNHP19995OtherHEALTH PARTNERS
MN1000878OtherPREFERRED ONE
MN107301OtherU CARE
MN01-02704OtherMEDICA-CHOICE