KEITH D LARSON


Address: 1511 Northway Dr, Suite 202, Saint Cloud, MN 56303-1261
Phone: 3202178880

KEITH D LARSON (NPI# 1639138431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1639138431
Entity Type Individual
Full Name KEITH D LARSON
Credential MD
Practice Address 1511 Northway Dr
Suite 202
Saint Cloud
MN 56303-1261
Practice Telephone 3202178880
Practice Fax Number 3202531822
Mailing Telephone 3202178880
Mailing Fax Number 3202531822
Enumeration Date 2006-03-21
Last Update Date 2009-09-01
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2084N0402X Psychiatry & Neurology
Specialization: Neurology with Special Qualifications in Child Neurology
22693 MN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MN 313593400 05

Other Providers KEITH LARSON

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1174036206 Keith Joseph Larson Jr. Pharmacist 4 Ne Pine Island Rd, Cape Coral, FL 33909-2560 2017-11-11
1952716425 Keith Larson Pharmacist 2600 Overlook Ln Nw, Mandan, ND 58554-1594 2014-06-24
1912027772 Keith Larson Physician Assistant 3901 Beaubien St, Detroit, MI 48201-2119 2007-03-29
1144231259 Keith C. Larson Dentist 915 N King St, Honolulu, HI 96817-4544 2006-08-11
1013931021 Keith Larson Physical Therapist 10450 Park Meadows Dr., Suite 103, Lone Tree, CO 80124 2006-07-26
1851353320 Keith William Larson Nurse Anesthetist, Certified Registered 3300 Oakdale Ave N, Robbinsdale, MN 55422-2926 2006-04-03
1740262401 Keith Rodney Larson Dentist 17895 Nw Evergreen Pkwy, Beaverton, OR 97006-7402 2005-11-17

Office Location

Street Address 1511 NORTHWAY DR
SUITE 202
City SAINT CLOUD
State MN
Zip Code 56303-1261

Providers in the same location

NPI Name Taxonomy Address Enumeration
1235105388 Julie M Johnson Family Medicine 1511 Northway Dr, Ste 103, Saint Cloud, MN 56303-1262 2006-02-28
1982937827 Keith Larson Neurology Pllc Clinic/Center 1511 Northway Dr, Suite 202, Saint Cloud, MN 56303-1261 2009-09-10
1194813808 Marc Dana Orjansen Dentist 1511 Northway Dr, Suite 202, Saint Cloud, MN 56303-1261 2006-10-10
1811923659 Mohamed Satti Yassin Specialist 1511 Northway Dr, Suite 101, Saint Cloud, MN 56303-1261 2006-06-23
1487691887 Dennis Lee Nierengarten Dentist 1511 Northway Dr, Suite 102, Saint Cloud, MN 56303-1261 2006-06-02

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841800463 Daniel P Lahr Radiologic Technologist St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 2020-08-07
1730798398 County of Stearns Case Management 705 Courthouse Square, St Cloud, MN 56303 2020-07-29
1669007126 Aflah Transportation LLC Non-emergency Medical Transport (VAN) 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 2020-03-05
1609420942 Stephanie Lynne Metzger Nurse Practitioner Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 2019-07-25
1306406947 Willow Tree Acupuncture LLC Acupuncturist 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 2019-06-17
1821553520 Alan Melvin Hoeper Nurse Anesthetist, Certified Registered Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 2019-02-06
1437644465 Brianna Larissa Justin Speech-Language Pathologist St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 2018-06-22
1780186486 Simplicity Health Pa Family Medicine 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 2018-03-08
1639682925 Dereje Beyene Respiratory Therapist, Certified 1406 15th Street North, Saint Cloud, MN 56303 2017-11-09
1740792761 Lisa Ann Horner Nurse Practitioner 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 2017-10-31
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Taxonomy Information

Taxonomy Code 2084N0402X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Neurology with Special Qualifications in Child Neurology

Taxonomy Definition

A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1346735750 Hicham Dabaja Psychiatry & Neurology 200 1st St Sw, Rochester, MN 55905-0001 2018-06-27
1205200383 Child Neurology Solutions Pllc Psychiatry & Neurology 360 Sherman St, Suite 399, Fort Road Medical Center, Saint Paul, MN 55102-2564 2015-11-30
1962829432 Jamie Marie Eskuri Psychiatry & Neurology 200 University Ave E, Saint Paul, MN 55101-2507 2014-03-23
1154607489 Janet Elgallab Psychiatry & Neurology 2828 Chicago Ave Ste 200, Minneapolis, MN 55407-1544 2011-11-01
1154563401 Amanda M Moen Psychiatry & Neurology 2450 Riverside Ave, Minneapolis, MN 55454-1450 2009-04-01
1306092655 Laura Catherine Speltz Psychiatry & Neurology 2512 S 7th St, Minneapolis, MN 55454-1404 2008-08-18
1154587863 Nitin Agarwal Psychiatry & Neurology 225 Smith Ave N, Saint Paul, MN 55102-2533 2008-08-01
1134318488 Nicole Jeanette Williams Doonan Psychiatry & Neurology 200 University Ave E, Saint Paul, MN 55101-2507 2007-10-22
1790997393 Sonya Grace Wang Psychiatry & Neurology 5775 Wayzata Blvd Ste 255, Minneapolis, MN 55416-1275 2007-05-04
1740360734 Beverly S Wical Psychiatry & Neurology 200 University Ave E, Saint Paul, MN 55101-2507 2006-10-16
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Competitor

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City SAINT CLOUD
Zip Code 56303

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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