Individual
KELLY JESTER GELDMACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8500
(618) 391-5711
Mailing address
4075 COPPER RIDGE DR, TRAVERSE CITY, MI 49684-7059
(800) 253-5358
(231) 932-4134
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036112201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112201-4
—
IL
Enumeration date
08/23/2006
Last updated
11/18/2009
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