Provider Demographics
NPI:1174750079
Name:KELLY, ALLA (MD)
Entity type:Individual
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First Name:ALLA
Middle Name:
Last Name:KELLY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2080 WOODWINDS DR
Mailing Address - Street 2:110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2523
Mailing Address - Country:US
Mailing Address - Phone:651-738-6800
Mailing Address - Fax:651-714-6997
Practice Address - Street 1:2080 WOODWINDS DR
Practice Address - Street 2:110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2523
Practice Address - Country:US
Practice Address - Phone:651-738-6800
Practice Address - Fax:651-714-6997
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2014-08-11
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Provider Licenses
StateLicense IDTaxonomies
MN56347207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology