Provider Demographics
NPI:1770664583
Name:KELLER, JOHN F (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:414 PLYMOUTH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6038
Mailing Address - Country:US
Mailing Address - Phone:616-454-3465
Mailing Address - Fax:616-454-9004
Practice Address - Street 1:414 PLYMOUTH AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6038
Practice Address - Country:US
Practice Address - Phone:616-454-3465
Practice Address - Fax:616-454-9004
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI054648207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4111797Medicaid
MIG13I927Medicare UPIN
MI0M30960005Medicare ID - Type UnspecifiedMEDICARE NUMBER