Provider Demographics
NPI:1962663468
Name:UDELHOFEN, KELLI MARIE CAMERON (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MARIE CAMERON
Last Name:UDELHOFEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5074
Mailing Address - Country:US
Mailing Address - Phone:319-369-7155
Mailing Address - Fax:319-861-6768
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5074
Practice Address - Country:US
Practice Address - Phone:319-369-7155
Practice Address - Fax:319-861-6768
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019430208000000X
OH34.012337208000000X
IADO-05684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics