Provider Demographics
NPI:1801887054
Name:KEATING, MARY U (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:U
Last Name:KEATING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29289207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51A35KEOtherBLUE CROSS BLUE SHIELD
598519OtherARAZ GROUP AMERICAS PPO
2116568OtherFIRST HEALTH PLAN
254015OtherPREFERRED ONE
599500400OtherMEDICAL ASSISTANCE
HP25465OtherHEALTH PARTNERS
0212393OtherMEDICA HEALTH PLANS
110410OtherUCARE
110410OtherUCARE
2116568OtherFIRST HEALTH PLAN
599500400OtherMEDICAL ASSISTANCE