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General NPI Number Information
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NPI Number | 1164917779
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Entity Type | Individual
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Provider Name | JOSEPH P KELLY DO
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Gender | Male
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 12555 W NATIONAL AVE STE 100
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City | NEW BERLIN
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State | WI
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Zip | 53151-4061
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Country | US
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Telephone | 262-395-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 12555 W NATIONAL AVE STE 100
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City | NEW BERLIN
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State | WI
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Zip | 53151-4061
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Country | US
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Telephone | 262-395-4141
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Fax | 262-395-4189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | O-1746
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 81454-21
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License Number State | WI
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