Provider Demographics
NPI:1386175925
Name:DUGGAN, KELLI DARLENE (MD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DARLENE
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:100 MALLARD CREEK RD STE 320
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5136
Practice Address - Country:US
Practice Address - Phone:502-855-6125
Practice Address - Fax:502-394-1972
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2024-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101283797207Q00000X
KY52883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine