MEDICARE: KELLI A HERTZ 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
1	207V00000X	Obstetrics & Gynecology Physician	01057454	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1538199591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI A HERTZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1008
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	1205 HADLEY RD STE 120
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1934
Country	:	US
Telephone Number	:	317-834-8960
Fax Number	:	317-834-8951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/16/2026

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Directions to “ KELLI A HERTZ M.D.” Practice Location

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