Provider Demographics
NPI:1528124880
Name:GEVAS, KELLI M (MD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:M
Last Name:GEVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:MARIE
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 MESSIMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-4677
Mailing Address - Fax:220-564-4678
Practice Address - Street 1:15 MESSIMER DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-4677
Practice Address - Fax:220-564-4678
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131614207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0234507Medicaid
WV3810007553Medicaid