Provider Demographics
NPI:1487877429
Name:KELLI G APPLEGATE MD LLC
Entity type:Organization
Organization Name:KELLI G APPLEGATE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:G
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-2776
Mailing Address - Street 1:727 MOUNT TABOR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6951
Mailing Address - Country:US
Mailing Address - Phone:812-948-2776
Mailing Address - Fax:812-948-2722
Practice Address - Street 1:727 MOUNT TABOR RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6951
Practice Address - Country:US
Practice Address - Phone:812-948-2776
Practice Address - Fax:812-948-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1040811305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE10092Medicare UPIN