Healthcare Provider Details

I. General information

NPI: 1750443271
Provider Name (Legal Business Name): JOLAN CSUS KELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 CITIGROUP CENTER
TAMPA FL
33610
US

IV. Provider business mailing address

7245 RIVER FOREST LN
TAMPA FL
33617-2612
US

V. Phone/Fax

Practice location:
  • Phone: 813-604-4336
  • Fax: 813-604-4337
Mailing address:
  • Phone: 813-541-1575
  • Fax: 813-436-9593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME81580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: