Individual
DR. GERALD A KELTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5693 YMCA PARK DR W, FORT WAYNE, IN 46835-3280
(260) 469-6603
(260) 486-6123
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044159A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595579
ANTHEM
IN
05
—
200009310
—
IN
01
—
POO465467
RAILROAD MEDICARE UPIN
IN
Enumeration date
08/21/2006
Last updated
10/07/2022
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