Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Mark Kim Kelly, MD

Individual provider Diagnostic Radiology Physician · NPI 1639300932

Dr. Mark Kim Kelly, MD is a Diagnostic Radiology in Fort Wayne, Indiana. Graduated from Wayne State University School of Medicine in 2009, 17 years ago. Practices with Fort Wayne Radiology Associates LLC, a 35-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
17
Trained at
Wayne State University School of Medicine
Licensed in
MI
In the registry since
2009
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone: (248) 787-4905
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 4301095025 (MI)

Record details

NPI number1639300932
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 4, 2009
Last updated in NPPESJanuary 27, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolWAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2009 (17 years in practice)
Group practice Fort Wayne Radiology Associates Llc — 35 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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