Individual
DR. DAVID W KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02003370A
IN
207L00000X
Anesthesiology Physician
RT1190
NH
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
RT1190
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000576532
ANTHEM PROVIDER NUMBER
IN
05
—
200910690
—
IN
Enumeration date
09/27/2006
Last updated
10/09/2008
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