Provider Demographics
NPI:1124032594
Name:KELLER, HOWARD I (MD)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:I
Last Name:KELLER
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 1:30 AULIKE ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2752
Mailing Address - Country:US
Mailing Address - Phone:808-262-6951
Mailing Address - Fax:808-261-7856
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 601
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2752
Practice Address - Country:US
Practice Address - Phone:808-262-6951
Practice Address - Fax:808-261-7856
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI34173OtherHAWAII MEDICAL SERVICE AS
HI03072201Medicaid
HIBDBFWMedicare ID - Type Unspecified
HI03072201Medicaid