Provider Demographics
NPI:1922197854
Name:KELLY, ANNE M (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE MMC 391
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-672-7122
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET
Practice Address - Street 2:PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-672-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN337872080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1274813OtherMEDICA-PRIMARY
768191OtherARAZ
MN1000079OtherPREFERRED ONE
MNHP21986OtherHEALTH PARTNERS
MN1224912OtherMEDICA-CHOICE
MN053876OtherFAIRVIEW
IA0908632Medicaid
MN100911OtherUCARE
MN7T749KEOtherBCBS
MN1274813OtherMEDICA-PRIMARY