Provider Demographics
NPI:1215967146
Name:KELLY, TARA LEE (MD)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:911 MARYLAND AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2647
Practice Address - Country:US
Practice Address - Phone:651-776-2719
Practice Address - Fax:651-771-3978
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-04-23
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Provider Licenses
StateLicense IDTaxonomies
MN50026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine