Provider Demographics
NPI:1215367727
Name:ISRAEL, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 MONTGOMERY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4460
Mailing Address - Country:US
Mailing Address - Phone:513-984-9355
Mailing Address - Fax:859-223-0642
Practice Address - Street 1:10615 MONTGOMERY RD STE 150
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4460
Practice Address - Country:US
Practice Address - Phone:513-984-9355
Practice Address - Fax:859-223-0642
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other