Provider Demographics
NPI:1023246915
Name:MING, KELLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:MING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-886-8471
Mailing Address - Fax:605-886-9317
Practice Address - Street 1:901 4TH ST NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1558
Practice Address - Country:US
Practice Address - Phone:605-886-8471
Practice Address - Fax:605-886-9317
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095068208600000X, 390200000X
SD9376208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program