Healthcare Provider Details

I. General information

NPI: 1730285214
Provider Name (Legal Business Name): JULIE C KELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ORANGE PL STE 2100
BEACHWOOD OH
44122-8400
US

IV. Provider business mailing address

PO BOX 74224
CLEVELAND OH
44194-0002
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-0100
  • Fax: 216-383-6481
Mailing address:
  • Phone: 216-383-6480
  • Fax: 216-383-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-073989
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-073989
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: