Healthcare Provider Details

I. General information

NPI: 1528863339
Provider Name (Legal Business Name): KAMRAN KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE STE 254
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE STE 254
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-1385
  • Fax:
Mailing address:
  • Phone: 612-626-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number36019
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: