Basic Information
| Provider Information | |||||||||
| NPI: | 1700849114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JEFFREY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4437 STATE ROUTE 159 STE 125 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794570 | ||||||||
| FaxNumber: | 7407794579 | ||||||||
| Practice Location | |||||||||
| Address1: | 4437 STATE ROUTE 159 | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456017065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794570 | ||||||||
| FaxNumber: | 7407794579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 35076888 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 000000000362661 | 01 | ANTHEM BCBS | OTHER | 2592001 | 05 | OH | MEDICAID | P00236852 | 01 | RAILROAD MEDICARE | OTHER | 2504684 | 01 | UNITED HEALTHCARE | OTHER | 130671 | 01 | NATIONWIDE | OTHER |