Individual
DR. MARK KIM KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(248) 787-4905
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(248) 787-4905
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301095025
MI
Other
Enumeration date
08/04/2009
Last updated
01/27/2016
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