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NPI Code Detail

MEDICARE: DR. KELLEY RAE LOCKHART M.D.

MEDICARE: DR. KELLEY RAE LOCKHART M.D.
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
1207RC0200XCritical Care Medicine (Internal Medicine) PhysicianDR.0054479CO
2207RP1001XPulmonary Disease Physician47972MN
3207RC0200XCritical Care Medicine (Internal Medicine) Physician01082503AIN

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 : 1033192679
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLEY RAE LOCKHART M.D.
Provider Business Mailing Address
First Line : 2222 N NEVADA AVE STE 4004
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-6832
Country : US
Telephone Number : 719-471-7064
Fax Number :
Provider Business Practice Location Address
First Line : 11104 PARKVIEW CIRCLE DR STE 110
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1673
Country : US
Telephone Number : 260-425-6780
Fax Number : 260-425-6789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 01/17/2023

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Directions to “ DR. KELLEY RAE LOCKHART M.D.” Practice Location

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