Individual
CHARLES WALTER KELLEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3401 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 788-9769
(317) 781-4868
Mailing address
3401 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 788-9769
(317) 781-4868
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
070000355
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100058130
—
IN
Enumeration date
08/11/2005
Last updated
05/16/2011
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