Provider Demographics
NPI:1871682229
Name:RIEDE, KELLER ANDREW JR (MD)
Entity Type:Individual
Prefix:MR
First Name:KELLER
Middle Name:ANDREW
Last Name:RIEDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200804010OtherMEDICAID - IN - NIS
KY50020902OtherPASSPORT - NIS
KYP00641377OtherRAILROAD KY MEDICARE - NIS
KY000000587061OtherANTHEM - NIS
KY099184OtherSIHO - NIS
KY2545169OtherUNITED HEALTH CARE
KYP00265558OtherMEDICARE RR
KY64117104Medicaid
KY000000373509OtherANTHEM
KY000023034OOtherHUMANA - NIS
KY00533071OtherMEDICARE - NIS
KY2706323OtherCIGNA - NIS
KY3856218OtherAETNA HMO ONLY
KY64117104OtherMEDICAID - NIS
KY7804714OtherAETNA
KY50008029OtherPASSPORT KY
KY50008029OtherPASSPORT KY
KYP00265558OtherMEDICARE RR
KY50020902OtherPASSPORT - NIS
KYI34728Medicare UPIN
IN200804010Medicaid