Provider Demographics
NPI:1811091424
Name:KELLER, MARTIN S (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:STE 6110, MSC 8235-49-6110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6022
Mailing Address - Fax:314-454-2442
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV SURG PED, STE 2A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6022
Practice Address - Fax:314-454-2442
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-08-02
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Provider Licenses
StateLicense IDTaxonomies
MO1066952086S0120X
VT042-00158392086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205096605Medicaid
ILENROLLEDMedicaid
MO004010943Medicare PIN