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General NPI Number Information
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NPI Number | 1023109022
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Entity Type | Individual
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Provider Name | DAVID W KELLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 2600 GREENBUSH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2477
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | LAFAYETTE
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State | IN
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Zip | 47903-5545
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Country | US
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Telephone | 765-448-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | RT1190
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | RT1190
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02003370A
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License Number State | IN
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