Healthcare Provider Details

I. General information

NPI: 1023244522
Provider Name (Legal Business Name): BRIAN ADAMS KELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DEPT ORTHOPAEDIC SURGERY, STE 6A/6B/12A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-3500
  • Fax: 314-878-7678
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-878-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number2016008226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: