Provider Demographics
NPI:1134231251
Name:KELLY, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1980 W HOSPITAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7802
Mailing Address - Country:US
Mailing Address - Phone:520-547-0433
Mailing Address - Fax:520-547-0435
Practice Address - Street 1:1980 W HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7802
Practice Address - Country:US
Practice Address - Phone:520-547-0433
Practice Address - Fax:520-547-0435
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-28
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Provider Licenses
StateLicense IDTaxonomies
AZ359212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159971Medicaid
AZ159971Medicaid
AZ112092Medicare PIN