Provider Demographics
NPI:1104828334
Name:KEPPLER, EDWARD L (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:KEPPLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2678
Mailing Address - Country:US
Mailing Address - Phone:765-660-7500
Mailing Address - Fax:765-662-3411
Practice Address - Street 1:330 N WABASH
Practice Address - Street 2:SUITE G20
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2555
Practice Address - Country:US
Practice Address - Phone:765-660-7600
Practice Address - Fax:765-651-7313
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026272174400000X
IN01031244A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100377800Medicaid
IN000000751385OtherANTHEM
IND94750Medicare UPIN
IN100377800Medicaid