Organization
KELLY MEDICAL SERVICES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN E. KELLY M.D. (PRESIDENT)
(262) 567-6927
Entity
Organization
Contact information
Practice address
820 E. SUMMIT AVE., OCONOMOWOC, WI 53066
(262) 567-6927
(262) 567-8003
Mailing address
820 E. SUMMIT AVE., OCONOMOWOC, WI 53066
(262) 567-6927
(262) 567-8003
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
24545
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30453000
—
WI
Enumeration date
10/02/2006
Last updated
08/22/2020
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