Provider Demographics
NPI:1871651968
Name:KELLER, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ
Mailing Address - Street 2:STE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4656
Mailing Address - Country:US
Mailing Address - Phone:402-330-1410
Mailing Address - Fax:402-330-4294
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4656
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-11-14
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Provider Licenses
StateLicense IDTaxonomies
NE19885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F69142Medicare UPIN