Individual
JOHN J KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
579 W MOORWOOD ST, GREEN VALLEY, AZ 85614-5980
(414) 737-9122
Mailing address
579 W MOORWOOD ST, GREEN VALLEY, AZ 85614-5980
(414) 737-9122
Taxonomy
Speciality
Code
Description
License number
State
207YX0602X
Otolaryngic Allergy Physician
25987
AZ
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
25987
AZ
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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