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General NPI Number Information
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NPI Number | 1124695671
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Entity Type | Individual
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Provider Name | MAIA KIRSTEN KELLER MD
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Gender | Female
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3290 N WELLNESS DR STE 240
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City | HOLLAND
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State | MI
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Zip | 49424-7261
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Country | US
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Telephone | 616-395-9379
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Fax | 616-257-1491
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Provider Business Mailing Address
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Address Line | 3434 RIVERTOWN POINT CT SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-3076
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Country | US
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Telephone | 616-257-3344
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Fax | 616-457-1491
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301515096
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | AI-4033089-2127
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License Number State | IA
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