Provider Demographics
NPI:1750590287
Name:MORAN, KELSEY J (MD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:J
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:615 VALLEY VIEW DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6180
Mailing Address - Country:US
Mailing Address - Phone:309-762-1072
Mailing Address - Fax:309-762-1094
Practice Address - Street 1:615 VALLEY VIEW DR.
Practice Address - Street 2:SUITE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6180
Practice Address - Country:US
Practice Address - Phone:309-762-1072
Practice Address - Fax:309-762-1094
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2017-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA389542085R0202X
WI63784-202085R0202X
IL036-1251922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology