Individual
DR. RICHARD L KELLER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
285 W 12TH ST STE 102, PERU, IN 46970-1654
(765) 472-4356
(260) 479-2927
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(765) 472-4356
(260) 479-2927
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01051573A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200327580
—
IN
Enumeration date
04/19/2006
Last updated
09/15/2021
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