MEDICARE: REBECCA H KELLY 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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	01028621A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000809673	OTHER	IN	ANTHEM
2	4352781	OTHER	IN	AETNA BEHAVIORAL HEALTH
3	000000810128	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1740385525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA H KELLY MD

Provider Business Mailing Address
First Line	:	7250 CLEARVISTA DR
Second Line	:	SUITE 327A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4692
Country	:	US
Telephone Number	:	317-621-7390
Fax Number	:	317-621-4494

Provider Business Practice Location Address
First Line	:	7250 CLEARVISTA DR
Second Line	:	SUITE 327A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4692
Country	:	US
Telephone Number	:	317-621-7390
Fax Number	:	317-621-4494

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/01/2015

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Directions to “ REBECCA H KELLY MD” Practice Location

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