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Individual

DIANE J KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 729-6166
(321) 952-9406
Mailing address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 729-6166
(321) 952-9406

Taxonomy

Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
ME47018
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
042339400
FL
01
160045705
RR MEDICARE
FL
Enumeration date
11/02/2005
Last updated
04/09/2010
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