Individual
MARY E KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
(815) 229-7585
Mailing address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
(815) 229-7585
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036107717
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020053661
RAILROAD MEDICARE
—
05
—
036107717
—
IL
Enumeration date
07/10/2006
Last updated
10/06/2015
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