Provider Demographics
NPI:1225297997
Name:KELLER, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
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 201
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2739
Mailing Address - Country:US
Mailing Address - Phone:808-261-4658
Mailing Address - Fax:
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2739
Practice Address - Country:US
Practice Address - Phone:808-261-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128254207X00000X
HI18249207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery