Provider Demographics
NPI:1124695671
Name:KELLER, MAIA KIRSTEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAIA
Middle Name:KIRSTEN
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3434 RIVERTOWN POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3076
Mailing Address - Country:US
Mailing Address - Phone:616-257-3344
Mailing Address - Fax:616-457-1491
Practice Address - Street 1:3290 N WELLNESS DR STE 240
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7261
Practice Address - Country:US
Practice Address - Phone:616-395-9379
Practice Address - Fax:616-257-1491
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2025-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301515096207N00000X
IAAI-4033089-2127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AI-4033089-2127OtherDEA