Provider Demographics
NPI:1306829676
Name:KELLER, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8260
Mailing Address - Country:US
Mailing Address - Phone:575-522-5955
Mailing Address - Fax:575-522-6228
Practice Address - Street 1:4351 E LOHMAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8260
Practice Address - Country:US
Practice Address - Phone:575-522-5955
Practice Address - Fax:575-522-6228
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2001231208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96339811Medicaid
NM96339811Medicaid