Organization
CENTRAL ILLINOIS ORTHOPEDIC SURGERY II LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT L KELLER D.O. (OWNER)
(309) 662-2278
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR, SUITE 220, BLOOMINGTON, IL 61701-3534
(309) 662-2278
(309) 663-2956
Mailing address
1505 EASTLAND DR, SUITE 220, BLOOMINGTON, IL 61701-3534
(309) 662-2278
(309) 663-2956
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571537801
BLUE CROSS BLUE SHIELD
IL
01
—
791203417
MEDICARE METRAHEALTH
IL
01
—
IL0101
JOHN DEERE
IL
Enumeration date
07/26/2006
Last updated
10/04/2022
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