Individual
MARK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-8358
(801) 581-2121
Mailing address
30 N 1900 E # 5R218, SALT LAKE CITY, UT 84132-0002
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
12888617-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2019
Last updated
08/28/2022
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