Individual
WAYNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MANKATO AVE, WINONA, MN 55987-4868
(507) 454-5050
(507) 454-5102
Mailing address
855 MANKATO AVE, WINONA, MN 55987-4868
(507) 454-5050
(507) 454-5102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27612
MN
207Q00000X
Family Medicine Physician
41795
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503567800
—
MN
Enumeration date
04/14/2006
Last updated
01/27/2012
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