Individual
MARK LOREN KELDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-117220
IL
208600000X
Surgery Physician
036117220
IL
2086S0129X
Vascular Surgery Physician
Primary
036-117220
IL
2086S0129X
Vascular Surgery Physician
59517
TN
Other
Enumeration date
07/14/2008
Last updated
06/25/2026
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