Provider Demographics
NPI:1851430896
Name:KELLER, KIMBERLIE (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BON AIR CTR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3000
Mailing Address - Country:US
Mailing Address - Phone:415-578-3095
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:350 BON AIR CTR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3000
Practice Address - Country:US
Practice Address - Phone:415-578-3095
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine