Provider Demographics
NPI:1770675399
Name:ROSS, KELLY D (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:140 W 4TH ST STE 1
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-1352
Mailing Address - Country:US
Mailing Address - Phone:641-736-4401
Mailing Address - Fax:641-736-4407
Practice Address - Street 1:140 W 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-1352
Practice Address - Country:US
Practice Address - Phone:641-736-4401
Practice Address - Fax:641-736-4407
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-05-19
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Provider Licenses
StateLicense IDTaxonomies
IA23076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07000OtherWELLMARK
IA0213892Medicaid
IA07000OtherWELLMARK
IA0213892Medicaid
IAA02359Medicare UPIN