Individual
MICHAEL J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1820 W 3RD ST, GENESIS HEALTH GROUP, DAVENPORT, IA 52802-1812
(563) 421-0500
(563) 326-1901
Mailing address
1820 WEST THIRD STREET, GENESIS HEALTH GROUP, DAVENPORT, IA 52802-0000
(563) 421-0500
(563) 326-1901
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-079295
IL
207Q00000X
Family Medicine Physician
Primary
24314
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14313
DEAN HEALTH PLAN
—
01
—
2019320
PHYSICIANS PLUS
—
01
—
390808509
CIGNA
—
01
—
390808509DX
UNITY
—
Enumeration date
07/21/2006
Last updated
02/15/2013
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