Healthcare Provider Details

I. General information

NPI: 1134101637
Provider Name (Legal Business Name): DAVID W KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

PO BOX 7232 DEPT 165
INDIANAPOLIS IN
46207-7232
US

V. Phone/Fax

Practice location:
  • Phone: 317-614-9817
  • Fax: 317-614-9655
Mailing address:
  • Phone: 866-282-7905
  • Fax: 800-731-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01033305
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: