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NPI Code Detail

MEDICARE: DR. MICHAEL GAYLOR KELLEY DDS

MEDICARE: DR. MICHAEL GAYLOR KELLEY DDS
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry12007484AIN

General Provider Information

NPI Number : 1316053770
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL GAYLOR KELLEY DDS
Provider Business Mailing Address
First Line : 6296 RUCKER RD
Second Line : STE A
City : INDIANAPOLIS
State : IN
Zip : 46220-4852
Country : US
Telephone Number : 317-253-5400
Fax Number : 317-254-9156
Provider Business Practice Location Address
First Line : 6296 RUCKER RD
Second Line : STE A
City : INDIANAPOLIS
State : IN
Zip : 46220-4852
Country : US
Telephone Number : 317-253-5400
Fax Number : 317-254-9156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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