Provider Demographics
NPI:1427060334
Name:AZUAR, KERI L (MD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:L
Last Name:AZUAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 4TH ST. E.
Mailing Address - Street 2:STE. 100
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1474
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:
Practice Address - Street 1:250 THOMPSON ST.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO454492085R0202X
MN654512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021768OtherKAISER COMMERCIAL NUMBER
CO54756219Medicaid
CO54756219Medicaid
COCOAAA0918Medicare PIN
COCOAAA0893Medicare PIN