Individual
MICHAEL J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
406 N 1ST ST, VINCENNES, IN 47591-1340
(812) 885-2750
(812) 885-2756
Mailing address
406 N 1ST ST, VINCENNES, IN 47591-1340
(812) 885-2750
(812) 885-2756
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029257
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000668746
ANTHEM
IN
05
—
100427270
—
IN
01
—
M400018771
MEDICARE
IN
01
—
P00851313
RAILROAD MEDICARE
IN
Enumeration date
12/08/2005
Last updated
07/21/2022
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