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Individual

AMY P KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
8400 WASHINGTON AVE, MOUNT PLEASANT, WI 53406-3735
(262) 321-3000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101020881
MI
207Q00000X
Family Medicine Physician
Primary
67431
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100070728
WI
Enumeration date
04/06/2014
Last updated
12/06/2023
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