# GEAUGA SPORTS MEDICINE

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

## Provider details

- **NPI number:** 1699834390
- **Authorized official:** MICHAEL KELLIS DO (PRESIDENT)
- **Authorized official phone:** (440) 285-1796

## Contact information

- **Practice address:** 11800 E WASHINGTON ST, AUBURN, OH 44023
- **Practice address phone:** (440) 285-6452
- **Mailing address:** 11800 E WASHINGTON ST, AUBURN, OH 44023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | NULL | Yes |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 01/13/2009