Kelley, Charles Walter

Kelley, Charles Walter is an individual health care provider with primary practice located at 3401 E Raymond St , Indianapolis IN 46203-4744. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot Surgery, which is considered as his primary health care specialty. Kelley, Charles Walter can be contacted via phone (317) 788-9769.

Contact Information

Primary practice address
3401 E Raymond St Indianapolis IN 46203-4744
Phone: (317) 788-9769
Fax: (317) 781-4868
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 070000355 Indiana

Profile Details

NPI number 1023010980
LBN Legal business name Kelley, Charles Walter
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated May 16th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023010980 NPPES
Indiana MEDICAID 100058130

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