Provider Demographics
NPI:1497721401
Name:KELLERMAN, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:KELLERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 TOWN CENTER DR STE 203
Mailing Address - Street 2:BEAUMONT MEDICAL STAFF AFFAIRS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD STE 248
Practice Address - Street 2:BEAUMONT CHRONIC DISEASE MANAGEMENT CLINIC
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-1515
Practice Address - Fax:248-551-1516
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-10-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301046818207RN0300X
WI45019207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology