Provider Demographics
NPI:1437135936
Name:KELLY, AMY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:NUMBER 622
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-227-9141
Mailing Address - Fax:651-265-6772
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:NUMBER 102
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-770-1385
Practice Address - Fax:651-770-0672
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN46573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0703794OtherMEDICA CHOICE
0703794OtherMEDICA PRIMARY
2130657OtherARAZ
826SOKEOtherBCBS
P00199150OtherRR MEDICARE
HP42083OtherEMHD
960981041136OtherPREICH PROVIDER NUMBER
960981041136OtherPREFERRED ONE
0703794OtherSELECT CARE
34495100OtherWISCONSIN MA
960981041136OtherPEAK PROVIDER NUMBER
P00199150OtherRR MEDICARE