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Individual
KEVIN M KELLY
Active
Individual
KEVIN M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MN 26969
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104320
MEDICA
—
01
—
080026085
RAILROAD MEDICARE
—
01
—
08625KE
BLUE CROSS
—
01
—
107074
UCARE MEDICAL ASSIST
—
01
—
107074C620
UCARE FOR SENIOR
—
05
—
505272600
—
MN
01
—
FP 3205
AMERICAS PPO
—
01
—
FP1420457002
PREFERRED ONE
—
Enumeration date
08/10/2005
Last updated
04/05/2012
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