MEDICARE: KELLY MARIE MEYER D.O.

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	02007038A	IN

General Provider Information

NPI Number	:	1912228750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE MEYER D.O.

Provider Business Mailing Address
First Line	:	30 W RAMPART ST STE 200
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-421-2012
Fax Number	:	317-398-1863

Provider Business Practice Location Address
First Line	:	2451 INTELLIPLEX DR STE 240
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8581
Country	:	US
Telephone Number	:	317-398-7337
Fax Number	:	317-398-1862

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	04/26/2023

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Directions to “ KELLY MARIE MEYER D.O.” Practice Location

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