Provider Demographics
NPI:1386868495
Name:KELLER, CHRISTIAN ERNST (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ERNST
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 1:2799 W GRAND BLVD STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2326
Mailing Address - Fax:313-916-2385
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:6TH FLOOR, W-630B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7176
Practice Address - Fax:313-916-2385
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099864207ZP0101X
NY243552-1207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7886108501Medicare PIN