Provider Demographics
NPI:1407870876
Name:KELLER, BRETT L (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:L
Last Name:KELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-662-2278
Mailing Address - Fax:309-663-2956
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-662-2278
Practice Address - Fax:309-663-2956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036110898207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL133229700OtherUS DEPARTMENT OF LABOR
IL678434OtherHEALTHLINK
IL0361100898OtherOSF CARE ADVANTAGE
IL036110898OtherUNITED HEALTHCARE
IL036110898 1Medicaid
IL5715378OtherBLUE CROSS BLUE SHIELD
IL036110898OtherOSF CARE PREFERRED
IL1302850001OtherADMINISTAR FEDERAL
ILIL0103OtherJOHN DEERE HEALTH
ILP00200415OtherMEDICARE METRAHEALTH
IL0361100898OtherOSF CARE ADVANTAGE