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General NPI Number Information
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NPI Number | 1861593063
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Entity Type | Organization
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Legal Business Name | MICHAEL I KELLER M.D. INC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 3633 CAMINO DEL RIO S #300
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City | SAN DIEGO
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State | CA
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Zip | 92108-4011
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Country | US
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Telephone | 619-287-9730
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Fax | 619-287-4516
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Provider Business Mailing Address
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Address Line | 3633 CAMINO DEL RIO S #300
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City | SAN DIEGO
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State | CA
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Zip | 92108-4011
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Country | US
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Telephone | 619-287-9730
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Fax | 619-287-4516
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL IRA KELLER
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Credential | M.D.
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Telephone | 619-287-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G28715
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License Number State | CA
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