Individual
KELLY KATHRYN HIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 N RITTER AVE STE 230, INDIANAPOLIS, IN 46219-3046
(317) 355-2960
(317) 355-7784
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 355-2960
(317) 355-7784
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01065176A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201064030
—
IN
01
—
P01723971
RR MEDICARE
IN
Enumeration date
05/28/2008
Last updated
06/18/2021
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