Individual
JAY S KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3140
(217) 383-4966
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036130109
IL
207V00000X
Obstetrics & Gynecology Physician
16383
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036130109
—
IL
05
—
101902
—
AL
01
—
1912966847
MEDICAID BILLING
AL
01
—
510I160042
MEDICARE PTAN
AL
01
—
51548375
BCBS
AL
01
—
D835
MEDICARE GROUP PIN
AL
Enumeration date
12/14/2005
Last updated
04/17/2020
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