Provider Demographics
NPI:1811087323
Name:KILLEEN, ANTHONY A (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE MMC 609
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-5443
Mailing Address - Fax:612-625-1121
Practice Address - Street 1:420 DELAWARE STREET SE
Practice Address - Street 2:760 MAYO MEMORIAL BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5443
Practice Address - Fax:612-625-1121
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-05-04
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Provider Licenses
StateLicense IDTaxonomies
MN30034207ZP0007X, 207ZP0104X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN041657600Medicaid
MN11-00014OtherMEDICA-PRIMARY
1696864OtherARAZ
MNHP38352OtherHEALTH PARTNERS
MN11-00232OtherMEDICA-CHOICE
MN102788OtherU CARE
MN1031950OtherPREFERRED ONE
MN102788OtherU CARE