Provider Demographics
NPI:1992714281
Name:MCKEAN, HEIDI ANN (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:MCKEAN
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 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1000 E. 23RD ST.
Practice Address - Street 2:STE. 230
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2122
Practice Address - Country:US
Practice Address - Phone:605-322-6900
Practice Address - Fax:605-322-6901
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48701207R00000X, 207RH0003X
SD7950207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00629285OtherMEDICARE RAILROAD
SD6006870Medicaid
MN698980000Medicaid
MNP00629285OtherMEDICARE RAILROAD
MNI 57848Medicare UPIN
MN698980000Medicaid