Individual
KEVIN R. KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5186
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5186
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
66691
WI
207K00000X
Allergy & Immunology Physician
C-8356
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039260B
—
OK
05
—
123411001
—
AR
01
—
5J075
AR BC/BS
AR
01
—
P00331539
RR MCR
AR
Enumeration date
06/17/2006
Last updated
05/23/2023
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