=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336433432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN WAYMAN KAEHR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2011
-----------------------------------------------------
Last Update Date | 12/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 E CARMEL DR STE 144
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-762-8194
-----------------------------------------------------
Fax | 317-762-8196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 ROSEHILL RD
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49202-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-212-2008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 01072625A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------