Provider Demographics
NPI:1003815895
Name:VANGILDER, KELLY M (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:VANGILDER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:770 NORTHPOINT PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:345 JUPITER LAKES BLVD
Practice Address - Street 2:STE 200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7100
Practice Address - Country:US
Practice Address - Phone:561-741-1957
Practice Address - Fax:561-741-1893
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2017-09-25
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Provider Licenses
StateLicense IDTaxonomies
FLOS07265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251951800Medicaid
FLP00192860OtherRAILROAD MEDICARE
FL251951800Medicaid
FLG73898Medicare UPIN