Individual
JOHN S KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 FRANKLIN ST, SUITE 200, MICHIGAN CITY, IN 46360-3563
(219) 872-6200
(219) 879-2915
Mailing address
PO BOX 2000, DYER, IN 46311-0900
(219) 864-2107
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
01024423A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200030090
—
IN
Enumeration date
09/19/2005
Last updated
02/13/2024
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