Provider Demographics
NPI:1407886047
Name:MCDONALD, KELLIE H (MD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:H
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE AVE
Practice Address - Street 2:ROOM 1204A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-6793
Practice Address - Fax:317-962-8281
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061770A2085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN959090ZZZQMedicare PIN
IN260220026Medicare PIN