Provider Demographics
NPI:1851504906
Name:KELLEE D FROGGE, MD,PSC
Entity Type:Organization
Organization Name:KELLEE D FROGGE, MD,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-465-0191
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:270-465-0463
Practice Address - Street 1:410 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1340
Practice Address - Country:US
Practice Address - Phone:270-465-0191
Practice Address - Fax:270-465-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64042393Medicaid
KYH47249Medicare UPIN
KY64042393Medicaid