Provider Demographics
NPI:1992270540
Name:KEELER, MARGARET AVILA (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:AVILA
Last Name:KEELER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W GEORGE ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4127
Mailing Address - Country:US
Mailing Address - Phone:708-833-3864
Mailing Address - Fax:
Practice Address - Street 1:1318 W GEORGE ST APT 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4127
Practice Address - Country:US
Practice Address - Phone:708-833-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant