Kelly, Kevin M

Kelly, Kevin M is an individual health care provider with primary practice located at 606 24Th Ave S 700, Minneapolis MN 55454-1455. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kelly, Kevin M can be contacted via phone (612) 672-2450.

Contact Information

Primary practice address
606 24Th Ave S 700 Minneapolis MN 55454-1455
Phone: (612) 672-2450
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MN 26969 Minnesota

Profile Details

NPI number 1578565560
LBN Legal business name Kelly, Kevin M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Apr 5th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578565560 NPPES
Other 08625KE BLUE CROSS
MEDICAID 505272600 BLUE CROSS
Other 0104320 BLUE CROSS
Other 080026085 BLUE CROSS
Other FP 3205 BLUE CROSS
Other 107074C620 BLUE CROSS
Other 107074 BLUE CROSS
Other FP1420457002 BLUE CROSS

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