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NPI Code Detail

MEDICARE: CHARLES WALTER KELLEY III DPM

MEDICARE: CHARLES WALTER KELLEY III DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist070000355IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023010980
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES WALTER KELLEY III DPM
Provider Business Mailing Address
First Line : 3401 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-788-9769
Fax Number : 317-781-4868
Provider Business Practice Location Address
First Line : 3401 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-788-9769
Fax Number : 317-781-4868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 05/16/2011

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