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General NPI Number Information
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NPI Number | 1508988353
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Entity Type | Individual
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Provider Name | EDWIN S CHELLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 289 IRELAND AVE
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City | FORT KNOX
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State | KY
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Zip | 40121-5111
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Country | US
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Telephone | 812-526-1135
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Fax | 812-526-1768
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Provider Business Mailing Address
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Address Line | 9 WISHING WELL CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4963
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Country | US
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Telephone | 630-363-5065
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-111266
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 430-10-72926
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 37525
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License Number State | SC
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