Healthcare Provider Details

I. General information

NPI: 1518999432
Provider Name (Legal Business Name): JOHN KING CELLETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

1919 STATE ST STE 324
NEW ALBANY IN
47150-6807
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-6742
  • Fax:
Mailing address:
  • Phone: 812-945-7536
  • Fax: 812-945-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number01031466
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: