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Individual
ANGELA DIANE KELLEY
Active
Individual
ANGELA DIANE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3562
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43522900
—
WI
05
—
465864
—
IA
Enumeration date
03/27/2006
Last updated
04/06/2021
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