Healthcare Provider Details

I. General information

NPI: 1144964883
Provider Name (Legal Business Name): SYDNEY KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

251 E HURON ST
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 312-926-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.179986
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: