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NPI Code Detail

MEDICARE: DR. MICHELE JANINE KELLER DO

MEDICARE: DR. MICHELE JANINE KELLER DO
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
1207Q00000XFamily Medicine Physician34006200OH
2207Q00000XFamily Medicine Physician02004192AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1KE-0807822OTHEROHPIN #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629158837
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELE JANINE KELLER DO
Provider Business Mailing Address
First Line : 1040 SIERRA DR
Second Line : SUITE 400
City : GREENWOOD
State : IN
Zip : 46143-7240
Country : US
Telephone Number : 317-528-4284
Fax Number : 317-865-8355
Provider Business Practice Location Address
First Line : 8135 CALUMET AVE
Second Line :
City : MUNSTER
State : IN
Zip : 46321-1701
Country : US
Telephone Number : 219-513-2000
Fax Number : 219-513-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 10/09/2020

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