Kelly, Charles E
Kelly, Charles E is an individual health care provider with primary practice located at 3050 Centre Pointe Drive Suite 200, Roseville MN 55113. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Other Service Providers / Specialist. Other Service Providers / Specialist is his primary health care specialty. Kelly, Charles E can be contacted via phone (651) 631-4242.Contact Information
Primary practice address
3050 Centre Pointe Drive Suite 200
Roseville MN 55113
Phone: (651) 631-4242
Fax: (651) 631-4260
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 26263 | Minnesota |
Other Service Providers / Specialist | 174400000X | 26263 | Minnesota |
Profile Details
NPI number | 1730123639 |
---|---|
LBN Legal business name | Kelly, Charles E |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 15th, 2006 |
Last updated | Feb 11th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1730123639 | NPPES |
Minnesota | MEDICAID | 286577 |
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