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Organization
THOMAS A. KELLY D.O. P.C.
Active
Organization
THOMAS A. KELLY D.O. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A KELLY D.O. (PRESIDENT)
(517) 663-2705
Entity
Organization
Contact information
Practice address
101 E SPICERVILLE HWY, EATON RAPIDS, MI 48827-1919
(517) 663-2705
(517) 663-9470
Mailing address
PO BOX 417, EATON RAPIDS, MI 48827-0417
(517) 663-2705
(517) 663-9470
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101008344
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100444
PHYSICIAN HEALTH PLAN
—
01
—
0152330085
BLUE CROSS BLUE SHIELD PPO TRUST
MI
01
—
0279722
CIGNA HEALTHCARE
—
01
—
10046150001
THE WELLNESS PLAN MEDICAID
MI
01
—
200000002219
PHYSICIAN HEALTH PLAN FAMILY CARE
MI
01
—
202869
MCLAREN
MI
05
—
3319192
—
MI
01
—
M034742
CHAMPUS
—
01
—
P93421
BLUE CARE NETWORK
MI
Enumeration date
01/14/2009
Last updated
01/14/2009
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