Healthcare Provider Details

I. General information

NPI: 1790715282
Provider Name (Legal Business Name): ARTHUR B KELLERT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35519 MICHIGAN AVE
WAYNE MI
48184
US

IV. Provider business mailing address

35519 E MICHIGAN AVE
WAYNE MI
48184-1682
US

V. Phone/Fax

Practice location:
  • Phone: 734-721-0561
  • Fax: 734-721-7583
Mailing address:
  • Phone: 734-721-0561
  • Fax: 734-721-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberAK000685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: