Provider Demographics
NPI:1679503098
Name:KELLING, DOUGLAS MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:KELLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 PARALLEL PKWY STE 121
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1655
Mailing Address - Country:US
Mailing Address - Phone:913-596-7230
Mailing Address - Fax:913-596-7228
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:STE 121
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112
Practice Address - Country:US
Practice Address - Phone:913-596-7230
Practice Address - Fax:913-596-7228
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1H68207PE0005X, 2083P0011X
KS05279962083P0011X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100167660CMedicaid
MOP01393087OtherRAIL ROAD
KSP00812188OtherRAIL ROAD
MO1679503098Medicaid
C51769Medicare UPIN
MOP01393087OtherRAIL ROAD
KSP00812188OtherRAIL ROAD