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NPI Code Detail

MEDICARE: MELISSA RENEE KELLER PA-C

MEDICARE: MELISSA RENEE KELLER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601004036MI

General Provider Information

NPI Number : 1326014218
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA RENEE KELLER PA-C
Provider Business Mailing Address
First Line : 6071 W OUTER DR
Second Line : DEPARTMENT OF SURGERY
City : DETROIT
State : MI
Zip : 48235-2624
Country : US
Telephone Number : 313-966-3300
Fax Number : 313-966-4773
Provider Business Practice Location Address
First Line : 6071 W OUTER DR
Second Line : DEPARTMENT OF SURGERY
City : DETROIT
State : MI
Zip : 48235-2624
Country : US
Telephone Number : 313-966-3300
Fax Number : 313-966-4773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 09/23/2013

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