Doctor Name: | DAVID M KELLEY |
NPI Number: | 1417112442 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 125054284 |
Business Practice Address: | 8348 Washington Ave Racine, WI - 534063733 |
Business Phone Number: | 2628844000 |
Business Fax Number: | 7082455604 |
Mailing Address: | 8348 Washington Ave, RACINE |
State: | WI |
Postal Code: | 534063733 |
Phone Number: | 2628844000 |
Fax Number: | 7082455604 |
NPI Enumeration Date: | 07/18/2008 |
NPI Last Update Date: | 01/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 125054284 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |