MEDICARE: DR. MATTHEW WILLIAM KELLER M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	01065977A	IN
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A156771	CA

General Provider Information

NPI Number	:	1710182795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW WILLIAM KELLER M.D.

Provider Business Mailing Address
First Line	:	PSC 475 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 475 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350-1200
Country	:	US
Telephone Number	:	860-885-9347
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	06/07/2026

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