Provider Demographics
NPI:1871837310
Name:KELLER, MICHAEL DANIEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1422
Mailing Address - Country:US
Mailing Address - Phone:218-409-2531
Mailing Address - Fax:
Practice Address - Street 1:430 5TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1422
Practice Address - Country:US
Practice Address - Phone:218-409-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health