MEDICARE: DR. MICHAEL E. KELLER D.D.S., M.S.D.

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
1	1223E0200X	Endodontics	12008103B	IN

General Provider Information

NPI Number	:	1841409661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. KELLER D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	3200 MIDDLE DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4426
Country	:	US
Telephone Number	:	812-372-3636
Fax Number	:	812-378-3636

Provider Business Practice Location Address
First Line	:	3200 MIDDLE DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4426
Country	:	US
Telephone Number	:	812-372-3636
Fax Number	:	812-378-3636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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