Provider Demographics
NPI:1013972835
Name:KEELEY, ELLEN CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CATHERINE
Last Name:KEELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100277
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-273-9065
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD BOX 100277
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240407207RI0011X
FLME132481207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021330500Medicaid
VA1013972835Medicaid
FLJA340ZOtherMEDICARE
TX100624902Medicaid
VA012991U92Medicare PIN
FLJA340ZOtherMEDICARE
VA1013972835Medicaid