Individual
KATHLEEN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4322 S LAFAYETTE BLVD, SOUTH BEND, IN 46614
(574) 391-1111
(574) 859-5040
Mailing address
1602 WAYNE ST, SOUTH BEND, IN 46615-1334
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01082520A
IN
Other
Enumeration date
04/07/2015
Last updated
12/18/2024
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