Provider Demographics
NPI:1770551798
Name:KELLER, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2845 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4185
Mailing Address - Country:US
Mailing Address - Phone:269-979-6305
Mailing Address - Fax:269-979-6329
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:SUITE 202
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4185
Practice Address - Country:US
Practice Address - Phone:269-979-6305
Practice Address - Fax:269-979-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3207679Medicaid
MI180130111OtherBCBSM
MIOM12280Medicare ID - Type UnspecifiedPROVIDER NUMBER
MI3207679Medicaid