Individual
DR. BRIAN J. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11365 DORSETT RD., MARYLAND HEIGHTS, MO 63043
(314) 872-6430
(314) 872-6500
Mailing address
11365 DORSETT RD., MARYLAND HEIGHTS, MO 63043
(314) 872-6430
(314) 872-6500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
105182
MO
2080N0001X
Neonatal-Perinatal Medicine Physician
105182
MO
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
105182
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057823
—
IL
05
—
207674029
—
MO
Enumeration date
07/17/2006
Last updated
03/26/2009
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