Healthcare Provider Details

I. General information

NPI: 1093377913
Provider Name (Legal Business Name): DAVID MICHAEL KELLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 SE 109TH TERRACE RD
SUMMERFIELD FL
34491-9015
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-618-2546
  • Fax:
Mailing address:
  • Phone: 352-618-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS23687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151013559
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS23687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: