Healthcare Provider Details

I. General information

NPI: 1043354483
Provider Name (Legal Business Name): KERRI A. KISSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL SQ STE 2200
GREENFIELD IN
46140-1378
US

IV. Provider business mailing address

1 MEMORIAL SQ STE 50
GREENFIELD IN
46140-1357
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-6662
  • Fax: 317-468-6275
Mailing address:
  • Phone: 317-468-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD430427
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD430427
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01083027A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: