MEDICARE: CAROLINE S. 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	174400000X	Specialist	200154	NM

General Provider Information

NPI Number	:	1568639979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE S. KELLER MD

Provider Business Mailing Address
First Line	:	PO BOX 5338
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-5338
Country	:	US
Telephone Number	:	505-989-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 MIGUEL CHAVEZ RD
Second Line	:	SUITE E
City	:	SANTA FE
State	:	NM
Zip	:	87505-6914
Country	:	US
Telephone Number	:	505-989-7222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLINE S KELLER
Credential	:	MD
Telephone Number	:	505-989-7222

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	06/03/2008

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