Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mick Kelly, MD

Individual provider Orthopaedic Surgery Physician · NPI 1053793208

Mick Kelly, MD is an Orthopedic Surgery in Pewaukee, Wisconsin. Graduated from University of Wisconsin School of Medicine in 2015, 11 years ago. Practices with Orthopaedic Associates of Wisconsin SC, a 106-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois, Utah and Wisconsin.

Years since qualifying
11
Trained at
University of Wisconsin School of Medicine
Licensed in
IL, UT, WI
In the registry since
2015
Specialties on file
3
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

N15W28300 Golf Rd
Pewaukee, WI 53072-4800
Phone: (262) 303-5055
Fax: (262) 303-5057
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 590 S Wakara Way, Salt Lake City, UT 84108-1200 — (801) 587-5400

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence 75716 (WI)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence 125066593 (IL)
Adult Reconstructive Orthopaedic Surgery Physician Taxonomy 207XS0114X · Licence 11729390-1205 (UT)

Record details

NPI number1053793208
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 24, 2015
Last updated in NPPESDecember 14, 2021
Certification dateDecember 14, 2021
Mailing addressN15w28300 Golf Rd, Pewaukee, WI 53072-4800

Medicare enrollment

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

Medicare specialtyORTHOPEDIC SURGERY
Medical schoolUNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
Graduated 2015 (11 years in practice)
Group practice Orthopaedic Associates Of Wisconsin Sc — 106 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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