Provider Demographics
NPI:1376705798
Name:KELLY, BRENDAN SEAN (DO)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:SEAN
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:KANSAS UNIVERSITY PHYSICIAN INC
Mailing Address - Street 2:3901 RAINBOW BLVD, 4070 DELP, MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:KU MEDICAL CENTER DIV OF GENERAL &
Practice Address - Street 2:3901 RAINBOW BLVD, MS 1020
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6005
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS9406982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine