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Individual

MR. KELLER ANDREW RIEDE JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
200 E CHESTNUT ST STE 303, LOUISVILLE, KY 40202-1831
(502) 629-5552
(502) 629-3132
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39447
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000373509
ANTHEM
KY
01
000000587061
ANTHEM - NIS
KY
01
000023034O
HUMANA - NIS
KY
01
00533071
MEDICARE - NIS
KY
01
099184
SIHO - NIS
KY
01
200804010
MEDICAID - IN - NIS
IN
01
2545169
UNITED HEALTH CARE
KY
01
2706323
CIGNA - NIS
KY
01
3856218
AETNA HMO ONLY
KY
01
50008029
PASSPORT KY
KY
01
50020902
PASSPORT - NIS
KY
01
64117104
MEDICAID - NIS
KY
05
64117104
KY
01
7804714
AETNA
KY
01
P00265558
MEDICARE RR
KY
01
P00641377
RAILROAD KY MEDICARE - NIS
KY
Enumeration date
10/12/2006
Last updated
07/21/2016
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