Provider Demographics
NPI:1285869081
Name:SCHULHOF, KEITH DOUGLAS
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DOUGLAS
Last Name:SCHULHOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1404
Mailing Address - Country:US
Mailing Address - Phone:651-690-5262
Mailing Address - Fax:
Practice Address - Street 1:1845 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1404
Practice Address - Country:US
Practice Address - Phone:651-690-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13648122300000X
IL0190279321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice