Healthcare Provider Details

I. General information

NPI: 1700849114
Provider Name (Legal Business Name): JOHN JEFFREY KELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159 SUITE 125
CHILLICOTHEE OH
45601-7065
US

IV. Provider business mailing address

4437 STATE ROUTE 159 STE 125
CHILLICOTHEE OH
45601-7065
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4570
  • Fax: 740-779-4579
Mailing address:
  • Phone: 740-779-4570
  • Fax: 740-779-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35076888
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: