Individual
KEVIN T KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1397 MEDICAL PARK BLVD, SUITE 240, WELLINGTON, FL 33414-3186
(561) 784-3788
(954) 229-3100
Mailing address
6333 N FEDERAL HWY, SUITE 300, FT LAUDERDALE, FL 33308-1907
(954) 776-6880
(954) 229-3100
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME56260
FL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
ME56260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055262300
—
FL
01
—
08555
BLUE CROSS BLUE SHIELD
FL
01
—
230941
AVMED
FL
01
—
4360358
AETNA
FL
Enumeration date
06/12/2006
Last updated
07/14/2021
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