Provider Demographics
NPI:1477572741
Name:KELLER, MICHAEL AARON
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AARON
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 5-7
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6874
Mailing Address - Country:US
Mailing Address - Phone:205-870-7110
Mailing Address - Fax:205-871-3339
Practice Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 5-7
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6874
Practice Address - Country:US
Practice Address - Phone:205-870-7110
Practice Address - Fax:205-871-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL44892Medicaid
U73195Medicare UPIN