Provider Demographics
NPI:1730738790
Name:LEMAIRE, KELLY J (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:LEMAIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 RANDOLPH WAY APT 235
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6760
Mailing Address - Country:US
Mailing Address - Phone:917-514-8823
Mailing Address - Fax:
Practice Address - Street 1:1037 W US HIGHWAY 90 STE 130
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3740
Practice Address - Country:US
Practice Address - Phone:386-487-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22769208D00000X
FLACN1467208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice