Individual
JOHN T KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6429
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6429
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
47350-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104874361
—
WI
01
—
P01443027
RAILROAD MEDICARE
WI
Enumeration date
05/04/2006
Last updated
01/27/2021
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