Individual
JOHN J KELEMEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 HOSPITAL CENTER BLVD STE 306, HILTON HEAD ISLAND, SC 29926-2739
(843) 689-8224
(843) 689-8360
Mailing address
PO BOX 21964, BELFAST, ME 04915-4116
(708) 342-6900
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01075452A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
04-31210
KS
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
34064
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001006309
ANTHEM PROVIDER NUMBER
IN
05
—
200326510A
—
KS
05
—
200326510D
—
KS
05
—
201291370
—
IN
Enumeration date
03/28/2006
Last updated
02/25/2019
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