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Individual
KELLY ELIZABETH MORTELL
Active
Individual
KELLY ELIZABETH MORTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01075131A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000928326
BCBS BMG VASCULAR INTERVENTIONAL RADIOLOGY
IN
01
—
000000951355
BCBS BMG VEIN SPECIALIST
IN
05
—
201289120
—
IN
Enumeration date
04/28/2009
Last updated
12/06/2017
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