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Contact Information

MICK KELLY, MD
N15W28300 GOLF RD
PEWAUKEE, WI53072-4800
 Phone: 262-303-5055
 Fax: 262-303-5057
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Adult Reconstructive Orthopaedic Surgery

207XS0114X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for MICK KELLY · (Male)

NPI # 1053793208
Status Active
Credentials MD
Entity Individual
Enumeration date 06/24/2015
Last updated 12/14/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 125066593
  • UT License # 11729390-1205
  • WI License # 75716
Hospital affiliation(s)
  • OCONOMOWOC MEMORIAL HSPTL - (Acute Care)
    791 E SUMMIT AVE
    OCONOMOWOC, WI 53066
  • WAUKESHA MEMORIAL HOSPITAL - (Acute Care)
    725 AMERICAN AVE
    WAUKESHA, WI 53188
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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