Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 336074831 | IL |
NPI | 1083815328 |
---|---|
Provider Name | Sarah June Keller |
First Address | Oak Park, IL 60304-1044 |
Second Address | Sturgeon Bay, WI 54235-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |