Provider Demographics
NPI:1184260705
Name:SAND, KEITH JOSEPH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:JOSEPH
Last Name:SAND
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:JOSEPH
Other - Last Name:SAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12195 NORWAY RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-4502
Mailing Address - Country:US
Mailing Address - Phone:320-363-4790
Mailing Address - Fax:320-363-4790
Practice Address - Street 1:12195 NORWAY RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MN
Practice Address - Zip Code:56310-4502
Practice Address - Country:US
Practice Address - Phone:320-363-4790
Practice Address - Fax:320-363-4790
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies