Keller, Jay S

Keller, Jay S is an individual health care provider with primary practice located at 611 W Park St , Urbana IL 61801-2529. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Keller, Jay S can be contacted via phone (217) 383-3140.

Contact Information

Primary practice address
611 W Park St Urbana IL 61801-2529
Phone: (217) 383-3140
Fax: (217) 383-4966
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 16383 Alabama
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 036130109 Illinois

Profile Details

NPI number 1790760544
LBN Legal business name Keller, Jay S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Apr 17th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790760544 NPPES
Illinois MEDICAID 036130109
Illinois Other 510I160042
Illinois Other D835
Illinois Other 1912966847
Illinois MEDICAID 101902
Illinois Other 51548375

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