Individual
MICHAEL KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10112 STEVENS AVE S, BLOOMINGTON, MN 55420-4934
(612) 990-8151
Mailing address
10112 STEVENS AVE S, BLOOMINGTON, MN 55420-4934
(612) 990-8151
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
MN
247200000X
Other Technician
—
—
Other
Enumeration date
08/25/2014
Last updated
03/29/2026
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