MEDICARE: MARK JOSEPH KELLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	G55252	CA
2	208800000X	Urology Physician	ME157212	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598827826	OTHER		INCORPORATION NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093889263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOSEPH KELLY MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-396-8930
Fax Number	:	239-396-8932

Provider Business Practice Location Address
First Line	:	8925 COLONIAL CENTER DR STE 2001
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7813
Country	:	US
Telephone Number	:	239-396-8930
Fax Number	:	239-396-8932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/10/2025

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Directions to “ MARK JOSEPH KELLY MD” Practice Location

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