Healthcare Provider Details

I. General information

NPI: 1629707831
Provider Name (Legal Business Name): LUKE KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E INTERSTATE AVE
BISMARCK ND
58503-1399
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-8800
  • Fax: 701-323-5492
Mailing address:
  • Phone: 605-328-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24159
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: