Provider Demographics
NPI:1255516399
Name:KELEKA MELA INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:KELEKA MELA INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:765-425-9709
Mailing Address - Street 1:11780 SAND CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8792
Mailing Address - Country:US
Mailing Address - Phone:317-509-0441
Mailing Address - Fax:317-579-1980
Practice Address - Street 1:1909 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-5129
Practice Address - Country:US
Practice Address - Phone:765-425-9709
Practice Address - Fax:317-579-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002983A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care