Individual
KELLY HALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 528-8148
Mailing address
PO BOX 7112, INDIANAPOLIS, IN 46207-7112
(317) 528-8148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101022403
MI
390200000X
Student in an Organized Health Care Education/Training Program
5101022403
MI
Other
Enumeration date
06/01/2016
Last updated
03/24/2021
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