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Organization
GEAUGA SPORTS MEDICINE
Active
Organization
GEAUGA SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KELLIS DO (PRESIDENT)
(440) 285-1796
Entity
Organization
Contact information
Practice address
11800 E WASHINGTON ST, AUBURN, OH 44023
(440) 285-6452
Mailing address
11800 E WASHINGTON ST, AUBURN, OH 44023
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
—
NULL
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
Other
Enumeration date
12/08/2006
Last updated
01/13/2009
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