Provider Demographics
NPI:1134189160
Name:KELLY, PATRICK WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3801 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6565
Mailing Address - Country:US
Mailing Address - Phone:605-306-6140
Mailing Address - Fax:605-306-6500
Practice Address - Street 1:3801 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6565
Practice Address - Country:US
Practice Address - Phone:605-306-6140
Practice Address - Fax:605-306-6500
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5251208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00144484Medicare PIN
SDI06727Medicare UPIN
SDS41993Medicare PIN
SDP00283909Medicare PIN