Keith M Heaton, M.D.
Surgery in St Louis Park, MN. Individual provider (NPI-1).
NPI number1962485508
StatusActive
Last updated in NPPESMar 9, 2021
Details
- NPI
- 1962485508
- Entity type
- Individual (NPI-1)
- Name
- Keith M Heaton
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 29, 2005
- Certification date
- Mar 9, 2021
- Last updated
- Mar 9, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | 43664 | MN | Yes |
Practice location
3850 Park Nicollet BlvdSt Louis Park, MN 55416-2527
Phone 952-993-3700 · Fax 952-993-1750
Mailing address
8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516
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