Individual
MICHAEL D KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47747-0001
(812) 450-3405
(812) 450-3099
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01054744A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000212792
BCBS - MARY STREET
IN
01
—
000000381080
BCBS - GATEWAY
IN
01
—
076673
HAMP #
IN
01
—
1973034
FIRST HEALTH #
IN
05
—
200353450
—
IN
01
—
470324
HEALTHLINK #
IN
05
—
64036205
—
KY
01
—
7127259
AETNA #
IN
Enumeration date
09/12/2006
Last updated
08/21/2012
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