Individual
BRENT L KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15954 RIVERS EDGE DR, HAYWARD, WI 54843-7800
(715) 634-2541
(715) 634-5740
Mailing address
15735 W US HIGHWAY 63, HAYWARD, WI 54843-6475
(888) 834-4551
(715) 598-4881
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39957
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30086600
—
WI
Enumeration date
07/13/2006
Last updated
10/16/2023
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