Individual
DR. KELLY CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2030 W BOULEVARD, KOKOMO, IN 46902-6079
(765) 454-0200
Mailing address
2030 W BOULEVARD, KOKOMO, IN 46902-6079
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01076541A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
01076541A
IN
207RC0000X
Cardiovascular Disease Physician
036151894
IL
208M00000X
Hospitalist Physician
2014009027
MO
Other
Enumeration date
07/05/2012
Last updated
12/14/2022
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