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General NPI Number Information
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NPI Number | 1831357722
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Entity Type | Individual
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Provider Name | KELLY KATHRYN HIATT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 1400 N RITTER AVE STE 230
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3046
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Country | US
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Telephone | 317-355-2960
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Fax | 317-355-7784
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone | 317-355-2960
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Fax | 317-355-7784
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01065176A
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License Number State | IN
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