Provider Demographics
NPI:1871567131
Name:KELLEY, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-351-6852
Mailing Address - Fax:319-351-2025
Practice Address - Street 1:269 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3645
Practice Address - Country:US
Practice Address - Phone:319-351-6852
Practice Address - Fax:319-351-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-18671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159277Medicaid
IA03090OtherBLUECROSS/BLUESHIELD
IA03090OtherBLUECROSS/BLUESHIELD
IAAK5213967OtherDEA
IAA01392Medicare UPIN