Basic Information
| Provider Information | |||||||||
| NPI: | 1851430896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | KIMBERLIE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 BON AIR CTR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949043000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155783095 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 BON AIR CTR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949043000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155783095 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11627 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.