Individual
CHARLES MICHAEL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7710 MERCY RD, SUITE 224, OMAHA, NE 68124-2372
(402) 399-8550
(402) 399-8455
Mailing address
17030 LAKESIDE HILLS PLZ, SUITE 200, OMAHA, NE 68130-2396
(402) 399-8550
(402) 399-8455
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
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