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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730123639 NPPES
Minnesota MEDICAID 286577

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