Provider Demographics
NPI:1700223930
Name:KELLY, GEORGE PATRICK (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PATRICK
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 EAST CAMPUS MALL
Mailing Address - Street 2:OFFICE #5139
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53175-1381
Mailing Address - Country:US
Mailing Address - Phone:608-265-5600
Mailing Address - Fax:608-263-6884
Practice Address - Street 1:333 EAST CAMPUS MALL
Practice Address - Street 2:OFFICE #5139
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53175-1381
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:608-263-6884
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN58080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine