Provider Demographics
NPI:1073608758
Name:JAMES L KELLER MD PC
Entity Type:Organization
Organization Name:JAMES L KELLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWIATEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-780-6077
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443
Mailing Address - Country:US
Mailing Address - Phone:231-780-6077
Mailing Address - Fax:
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4185
Practice Address - Country:US
Practice Address - Phone:269-979-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI066800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3207676Medicaid
MI4900770001Medicare NSC
MIB54066Medicare UPIN
0M12280Medicare ID - Type Unspecified