Healthcare Provider Details

I. General information

NPI: 1578876116
Provider Name (Legal Business Name): KELLY CARLBERG GRANER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY NICOLE CARLBERG M.D.

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W COUNTY LINE RD STE 3000
GREENWOOD IN
46142-5195
US

IV. Provider business mailing address

10767 ILLINOIS ST STE 3000
CARMEL IN
46032-8972
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-1200
  • Fax: 317-817-1220
Mailing address:
  • Phone: 317-817-1200
  • Fax: 317-817-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01077262A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301096543
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number63083
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01077262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: