Mortell, Kelly Elizabeth
Mortell, Kelly Elizabeth is an individual health care provider with primary practice located at 621 Memorial Dr Ste 312, South Bend IN 46601-1063. She recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology, which is considered as her primary health care specialty. Mortell, Kelly Elizabeth can be contacted via phone (574) 647-5200.Contact Information
Primary practice address
621 Memorial Dr Ste 312
South Bend IN 46601-1063
Phone: (574) 647-5200
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 01075131A | Indiana |
Profile Details
| NPI number | 1841434354 |
|---|---|
| LBN Legal business name | Mortell, Kelly Elizabeth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 28th, 2009 |
| Last updated | Dec 6th, 2017 - about 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841434354 | NPPES |
| Indiana | Other | 000000951355 | BCBS BMG VEIN SPECIALIST |
| Indiana | MEDICAID | 201289120 | BCBS BMG VEIN SPECIALIST |
| Indiana | Other | 000000928326 | BCBS BMG VEIN SPECIALIST |
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