Provider Demographics
NPI:1538124888
Name:KELLER, BOWEN ELIOT (MD)
Entity type:Individual
Prefix:DR
First Name:BOWEN
Middle Name:ELIOT
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 OSBORNE RD NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2718
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:550 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2718
Practice Address - Country:US
Practice Address - Phone:763-236-5000
Practice Address - Fax:763-236-3524
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55Q07KEOtherBCBS OF MN
MN5366669OtherAETNA
MN779466OtherAMERICA'S PPO
MN124494OtherUCARE
MN0413830OtherMEDICA
MN1017337OtherPREFERRED ONE
MNHP26738OtherHEALTHPARTNERS
MN476817500Medicaid