Provider Demographics
NPI:1164917779
Name:KELLY, JOSEPH P (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:KELLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 W NATIONAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-395-4141
Mailing Address - Fax:262-395-4189
Practice Address - Street 1:12555 W NATIONAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-395-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1746207X00000X
WI81454-21207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery