# THOMAS A. KELLY D.O. P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366689275
- **Authorized official:** DR. THOMAS A KELLY D.O. (PRESIDENT)
- **Authorized official phone:** (517) 663-2705

## Contact information

- **Practice address:** 101 E SPICERVILLE HWY, EATON RAPIDS, MI 48827-1919
- **Practice address phone:** (517) 663-2705
- **Practice address fax:** (517) 663-9470
- **Mailing address:** PO BOX 417, EATON RAPIDS, MI 48827-0417
- **Mailing address phone:** (517) 663-2705
- **Mailing address fax:** (517) 663-9470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 5101008344 | MI | Yes |

## Other

- **Enumeration date:** 01/14/2009
- **Last updated:** 01/14/2009

## 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 |