Individual
CHARLES MICHAEL KELLY
Active
Individual
CHARLES MICHAEL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16976
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03880
BCBS OF NEBRASKA
NE
01
—
09-00180
SHARE ADVANTAGE/MERCY RD
NE
01
—
09-01137
SHARE ADVANTAGE/LAKESIDE
NE
05
—
0989095
—
IA
01
—
16404
MIDLANDS CHOICE
NE
05
—
47063010113
—
NE
Enumeration date
06/09/2006
Last updated
04/18/2019
Update your record
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