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7469 Nw 4th St Plantation FL 33317-2216 | |
| (954) 792-0772 | |
| (954) 792-1221 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7469 Nw 4th St, Plantation, Florida |
| Authorized Official Name and Position | Nathaniel Keller (OWNER PRESIDENT) |
| Authorized Official Contact | 9547920772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7469 Nw 4th St Plantation FL 33317-2216 Ph: (954) 792-0772 | 7469 Nw 4th St Plantation FL 33317-2216 Ph: (954) 792-0772 |
| NPI Number | 1245306810 |
|---|---|
| Provider Enumeration Date | 11/27/2006 |
| Last Update Date | 12/13/2007 |
| Medicare PECOS PAC ID | 8325002959 |
|---|---|
| Medicare Enrollment ID | O20041115000305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245306810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME87905 (Florida) | Primary |
| Provider Name | Nathaniel A Keller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144411844 PECOS PAC ID: 6406810043 Enrollment ID: I20041116000311 |
| Provider Name | Ramsey K Pevsner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841223559 PECOS PAC ID: 5092712869 Enrollment ID: I20061109000119 |
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