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NPI Code Detail

MEDICARE: PHILIP E KELLER MD

MEDICARE: PHILIP E KELLER MD
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 Physician23984WI
2207Q00000XFamily Medicine Physician01066617AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080076573OTHERWIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
212550OTHERWIDEAN
323984OTHERWITOUCHPOINT
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
539080723640OTHERWIUNITY
6000000631756OTHERINANTHEM PROVIDER NUMBER
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8WI0140OTHERWIJOHN DEERE

General Provider Information

NPI Number : 1972585131
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP E KELLER MD
Provider Business Mailing Address
First Line : PO BOX 5545
Second Line :
City : LAFAYETTE
State : IN
Zip : 47903-5545
Country : US
Telephone Number : 765-448-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1 WALTER SCHOLER DR
Second Line :
City : LAFAYETTE
State : IN
Zip : 47909-6303
Country : US
Telephone Number : 765-448-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 08/13/2012

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Directions to “ PHILIP E KELLER MD” Practice Location

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