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General NPI Number Information
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NPI Number | 1750323747
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Entity Type | Individual
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Provider Name | KEVIN T KELLY MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 1397 MEDICAL PARK BLVD SUITE 240
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City | WELLINGTON
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State | FL
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Zip | 33414-3186
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Country | US
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Telephone | 561-784-3788
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Fax | 954-229-3100
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Provider Business Mailing Address
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Address Line | 6333 N FEDERAL HWY SUITE 300
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-1907
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Country | US
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Telephone | 954-776-6880
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Fax | 954-229-3100
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME56260
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | ME56260
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License Number State | FL
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