Individual
KELLY R BURSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3201 MIDDLE DR, COLUMBUS, IN 47203-4427
(812) 372-8281
(812) 372-4525
Mailing address
2502 25TH ST, COLUMBUS, IN 47201-3728
(812) 372-8883
(812) 373-3266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01064404
IN
207Q00000X
Family Medicine Physician
01064404A
IN
207Q00000X
Family Medicine Physician
11012345
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200886140
—
IN
Enumeration date
06/22/2007
Last updated
06/03/2015
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