Individual
NADINE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
901 MACARTHUR BLVD, PATHOLOGY DEPARTMENT, MUNSTER, IN 46321-2901
(219) 836-4622
Mailing address
9201 CALUMET AVE, MUNSTER, IN 46321-2807
(219) 836-2022
(219) 836-0034
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01059592A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200490010
—
IN
Enumeration date
09/20/2005
Last updated
09/13/2012
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