Provider Demographics
NPI:1790928497
Name:KELLER, EMILY CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 E COUNTY LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1066
Mailing Address - Country:US
Mailing Address - Phone:317-215-0928
Mailing Address - Fax:317-743-8148
Practice Address - Street 1:521 E COUNTY LINE RD STE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1066
Practice Address - Country:US
Practice Address - Phone:317-215-0928
Practice Address - Fax:317-743-8148
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072313A207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3089001Medicare PIN