Provider Demographics
NPI:1588808489
Name:KELDERMAN, JESSICA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:KELDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 WALL ST STE 260
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7937
Mailing Address - Country:US
Mailing Address - Phone:608-807-1608
Mailing Address - Fax:608-467-1425
Practice Address - Street 1:5315 WALL ST STE 260
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7937
Practice Address - Country:US
Practice Address - Phone:608-807-1600
Practice Address - Fax:608-467-1425
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55339-020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice