Individual
KELLY LOUIS GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1263 HOSPITAL DR NW, SUITE 250, CORYDON, IN 47112-2172
(812) 738-8136
(812) 738-3155
Mailing address
1263 HOSPITAL DR NW, SUITE 250, CORYDON, IN 47112-2172
(812) 738-8136
(812) 738-3155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048923A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000335255
ANTHEM
IN
05
—
200266000
—
IN
01
—
P00200004
RR MEDICARE
IN
Enumeration date
10/11/2005
Last updated
12/03/2020
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