Provider Demographics
NPI:1528172772
Name:KELLERMEIER, JENS P (MD)
Entity type:Individual
Prefix:
First Name:JENS
Middle Name:P
Last Name:KELLERMEIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE A201
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8411
Mailing Address - Country:US
Mailing Address - Phone:815-385-0084
Mailing Address - Fax:815-385-8968
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE A201
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8411
Practice Address - Country:US
Practice Address - Phone:815-385-0084
Practice Address - Fax:815-385-8968
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109375207L00000X
IL036109375207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology