Provider Demographics
NPI:1902032030
Name:SCHAUB, KELLIE MICHELLE
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MICHELLE
Last Name:SCHAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MEDICAL DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-844-4155
Mailing Address - Fax:
Practice Address - Street 1:370 MEDICAL DR.
Practice Address - Street 2:STE B
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-844-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120108731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics