Active NPI
Elijah Keller
- Dentist
- Michigan City, IN
National Provider Identifier
1710871108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12014755A
- Practice address
- 1213 E Coolspring Ave
Michigan City, IN 46360-6319 - Phone
- (269) 870-5105
- NPI assigned
- Jun 9, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12014755A | IN | Primary |
Addresses
Primary practice location
1213 E Coolspring Ave
Michigan City, IN 46360-6319
Mailing address
1213 E Coolspring Ave
Michigan City, IN 46360-6319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12014755A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749427200000",
"number": "1710871108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1213 E COOLSPRING AVE",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463606319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1213 E COOLSPRING AVE",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463606319",
"telephone_number": "269-870-5105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "ELIJAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-09",
"last_updated": "2025-06-09",
"certification_date": "2025-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12014755A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.