Provider Demographics
NPI:1497710693
Name:MCINTYRE, KELLEY M (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:MCINTYRE
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR STE LL2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1360
Practice Address - Country:US
Practice Address - Phone:502-636-8095
Practice Address - Fax:502-636-8097
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36930207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY012818OtherSIHO / NCMA
KY1165398OtherPASSORT / NCM A
KY110235754OtherRAILROAD MEDICARE
KY000000225552OtherANTHEM / NCMA
KY64048663Medicaid
KY000023029EOtherHUMANA / NCMA
IN200532250Medicaid
KY2439944000OtherPASSPORT ADVANTAGE
KY000000225552OtherANTHEM / NCMA
KY000023029EOtherHUMANA / NCMA