Kelly, Wayne
Kelly, Wayne is an individual health care provider with primary practice located at 855 Mankato Ave , Winona MN 55987-4868. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kelly, Wayne can be contacted via phone (507) 454-5050.Contact Information
Primary practice address
855 Mankato Ave
Winona MN 55987-4868
Phone: (507) 454-5050
Fax: (507) 454-5102
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 27612 | Minnesota |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 41795 | Wisconsin |
Profile Details
| NPI number | 1831153972 |
|---|---|
| LBN Legal business name | Kelly, Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Jan 27th, 2012 - about 12 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 | 1831153972 | NPPES |
| Minnesota | MEDICAID | 503567800 |
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