Individual
DR. CHARLES E KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3050 CENTRE POINTE DRIVE, SUITE 200, ROSEVILLE, MN 55113
(651) 631-4242
(651) 631-4260
Mailing address
3050 CENTRE POINTE DRIVE, SUITE 200, ROSEVILLE, MN 55113
(651) 639-9150
(651) 639-9153
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26263
MN
207R00000X
Internal Medicine Physician
26263
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286577
—
MN
Enumeration date
06/15/2006
Last updated
02/11/2016
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