Individual
KEVIN J KELLY
Active
Individual
KEVIN J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01032406A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641087
ANTHEM
IN
05
—
0522401
—
OH
01
—
060070567
RR MEDICARE
IN
01
—
060071114
RR MEDICARE
OH
01
—
06199
MEDICAID OHIO PARAMONT
OH
05
—
100360760
—
IN
01
—
P00786817
R.R. MEDICARE
IN
01
—
P00846125
MEDICARE RAILROAD
OH
Enumeration date
08/15/2005
Last updated
11/29/2016
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