Healthcare Provider Details

I. General information

NPI: 1063602811
Provider Name (Legal Business Name): SUSAN ANN KEILER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N 25TH ST
SHEBOYGAN WI
53081-3108
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-9100
  • Fax: 920-457-1461
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number55323-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: