MEDICARE: MICHAEL PAUL KELLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2001231	NM
2	2086S0129X	Vascular Surgery Physician	2001231	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306829676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAUL KELLER MD

Provider Business Mailing Address
First Line	:	4351 E LOHMAN AVE STE 202
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8260
Country	:	US
Telephone Number	:	575-522-5955
Fax Number	:	575-522-6228

Provider Business Practice Location Address
First Line	:	4351 E LOHMAN AVE STE 202
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8260
Country	:	US
Telephone Number	:	575-522-5955
Fax Number	:	575-522-6228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/09/2020

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Directions to “ MICHAEL PAUL KELLER MD” Practice Location

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