Individual
KEVIN M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
606 24TH AVE S, 700, MINNEAPOLIS, MN 55454-1455
(612) 672-2450
Mailing address
606 24TH AVE S, 700, MINNEAPOLIS, MN 55454-1455
(612) 672-2450
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MN 26969
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104320
MEDICA
—
01
—
080026085
RAILROAD MEDICARE
—
01
—
08625KE
BLUE CROSS
—
01
—
107074
UCARE MEDICAL ASSIST
—
01
—
107074C620
UCARE FOR SENIOR
—
05
—
505272600
—
MN
01
—
FP 3205
AMERICAS PPO
—
01
—
FP1420457002
PREFERRED ONE
—
Enumeration date
08/10/2005
Last updated
04/05/2012
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