Provider Demographics
NPI:1225071871
Name:SEIFERT, KELLY J (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:SEIFERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 WATERMARK DR
Mailing Address - Street 2:STE 420
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1072
Mailing Address - Country:US
Mailing Address - Phone:614-859-1900
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1002
Practice Address - Country:US
Practice Address - Phone:614-645-2700
Practice Address - Fax:614-645-2727
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641636Medicaid
FL4205761Medicare Oscar/Certification
OHH062904Medicare PIN
OHH062903Medicare PIN
I51780Medicare UPIN
OH2641636Medicaid
OHH062902Medicare PIN
OHH062901Medicare PIN