Provider Demographics
NPI:1467434928
Name:FROGGE, KELLEE D (MD)
Entity Type:Individual
Prefix:MRS
First Name:KELLEE
Middle Name:D
Last Name:FROGGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 HOTCHKISS ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1340
Mailing Address - Country:US
Mailing Address - Phone:270-465-0191
Mailing Address - Fax:270-464-0463
Practice Address - Street 1:105 GREENBRIAR DR
Practice Address - Street 2:SUITE B
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-465-0191
Practice Address - Fax:270-465-0463
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6404239300Medicaid
KYH47249Medicare UPIN
KY6404239300Medicaid