Provider Demographics
NPI:1518943554
Name:KELLY, MAUREEN E (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:4491 BENT BROTHERS BLVD.
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-9990
Practice Address - Country:US
Practice Address - Phone:719-595-7525
Practice Address - Fax:719-595-7965
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM88 214207R00000X
CO45238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27064Medicaid
CO46323040Medicaid
CO46323040Medicaid
NM27064Medicaid