Provider Demographics
NPI:1578026969
Name:KELLER, DAVID M II (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KELLER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6785 MYERS LAKE AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7415
Mailing Address - Country:US
Mailing Address - Phone:616-884-5191
Mailing Address - Fax:616-884-5192
Practice Address - Street 1:6785 MYERS LAKE AVE NE STE B
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7415
Practice Address - Country:US
Practice Address - Phone:616-884-5191
Practice Address - Fax:616-884-5192
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101026809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program