Individual
JACK D KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1008 W. CHERRY ST., SUITE F, MARION, IL 62959
(618) 997-2919
(618) 997-6851
Mailing address
1008 W CHERRY ST STE F, MARION, IL 62959-1998
(618) 997-2919
(618) 997-6851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036056531
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036056531
—
IL
Enumeration date
12/24/2007
Last updated
02/20/2013
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