Individual
MR. TIMOTHY JOSEPH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-5100
(317) 621-7896
Mailing address
6626 E 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01028972
IN
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
01028972
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000078852
ANTHEM
IN
01
—
000000871726
ANTHEM
IN
01
—
000000871759
ANTHEM
IN
01
—
000000872285
ANTHEM
IN
05
—
100333150
—
IN
Enumeration date
08/29/2006
Last updated
08/27/2025
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