Provider Demographics
NPI:1871587246
Name:KINDWALL- KELLER, TAMILA L (DO)
Entity type:Individual
Prefix:
First Name:TAMILA
Middle Name:L
Last Name:KINDWALL- KELLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7800
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007582207RH0000X, 207RH0003X
VA0102202838207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7001627OtherAETNA
OH730908OtherBUCKEYE
P00432049OtherRAILROAD MEDICARE
OH000000539573OtherANTHEM
IN200485360Medicaid
OH2489196Medicaid
OH000000224462OtherUNISON
KY64086093Medicaid
OH363704OtherWELLCARE
OH7001627OtherAETNA
OH2489196Medicaid
OHKI4192872Medicare PIN