Provider Demographics
NPI:1215985130
Name:KELLEY-PATTESON, CHRISTINE L (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:L
Last Name:KELLEY-PATTESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 106TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1004
Mailing Address - Country:US
Mailing Address - Phone:317-575-0330
Mailing Address - Fax:317-846-5719
Practice Address - Street 1:170 W 106TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1004
Practice Address - Country:US
Practice Address - Phone:317-575-0330
Practice Address - Fax:317-846-5719
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050353A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING37776Medicare UPIN
IN117890CMedicare ID - Type Unspecified
IN117890CMedicare ID - Type Unspecified