MEDICARE: JOHN J KELEMEN III 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	04-31210	KS
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	34064	WI
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	01075452A	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000001006309	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1871554212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J KELEMEN III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 21964
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4116
Country	:	US
Telephone Number	:	708-342-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 HOSPITAL CENTER BLVD STE 306
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-2739
Country	:	US
Telephone Number	:	843-689-8224
Fax Number	:	843-689-8360

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	02/25/2019

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