Provider Demographics
NPI:1285606731
Name:WOLTEMATH, KELLI ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ELIZABETH
Last Name:WOLTEMATH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ELIZABETH
Other - Last Name:CHESNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:IA
Mailing Address - Zip Code:51640-1300
Mailing Address - Country:US
Mailing Address - Phone:712-382-2626
Mailing Address - Fax:712-382-1931
Practice Address - Street 1:1219 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:IA
Practice Address - Zip Code:51640-1300
Practice Address - Country:US
Practice Address - Phone:712-382-2626
Practice Address - Fax:712-382-1931
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0062356Medicaid
IA29447OtherWELLMARK BC/BS OF IA
E35367Medicare UPIN
IA29447Medicare ID - Type Unspecified