Provider Demographics
NPI:1255332672
Name:COLOMB, KELLY J (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:COLOMB
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1214 SPRING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3704
Mailing Address - Country:US
Mailing Address - Phone:812-283-5950
Mailing Address - Fax:812-285-5439
Practice Address - Street 1:1214 SPRING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-283-5950
Practice Address - Fax:812-285-5439
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-01-21
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Provider Licenses
StateLicense IDTaxonomies
IN01038348A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100362720Medicaid
IN100362720Medicaid
IN241120JMedicare Oscar/Certification
INE60434Medicare UPIN
IN241630JMedicare Oscar/Certification