MEDICARE: DR. PENNY ELIZABETH KALLMYER MD

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	208000000X	Pediatrics Physician	01041481A	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	000000093913	OTHER		ANTHEM

General Provider Information

NPI Number	:	1538256920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY ELIZABETH KALLMYER MD

Provider Business Mailing Address
First Line	:	6640 PARKDALE PLACE
Second Line	:	SUITE U
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4698
Country	:	US
Telephone Number	:	317-291-5190
Fax Number	:	317-291-1510

Provider Business Practice Location Address
First Line	:	6640 PARKDALE PLACE
Second Line	:	SUITE U
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4698
Country	:	US
Telephone Number	:	317-291-5190
Fax Number	:	317-291-1510

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/08/2011

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