Individual
KIMBERLY D KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12100 DIX TOLEDO RD, SOUTHGATE, MI 48195-3531
(734) 282-5502
Mailing address
12100 DIX TOLEDO RD, SOUTHGATE, MI 48195-3531
(734) 282-5502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004611
MI
Other
Enumeration date
02/10/2010
Last updated
02/10/2010
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