MEDICARE: MICHAEL G KELLER DO

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	207R00000X	Internal Medicine Physician	F1700	TX

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	:	1417945734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL G KELLER DO

Provider Business Mailing Address
First Line	:	3133 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5421
Country	:	US
Telephone Number	:	409-962-7606
Fax Number	:	409-962-6027

Provider Business Practice Location Address
First Line	:	3133 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651
Country	:	US
Telephone Number	:	409-962-7606
Fax Number	:	409-962-6027

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	05/31/2018

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