Provider Demographics
NPI:1851616627
Name:DARMODY, KELLY JEAN (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:DARMODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2439
Mailing Address - Country:US
Mailing Address - Phone:262-421-5135
Mailing Address - Fax:414-488-1407
Practice Address - Street 1:1421 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2439
Practice Address - Country:US
Practice Address - Phone:262-421-5135
Practice Address - Fax:414-488-1407
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5685920207R00000X
WI56859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine