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Organization
MAUREEN A KELLY MD PLLC
Active
Organization
MAUREEN A KELLY MD PLLC
Active
Other names
BLOOMFIELD PEDIATRIC CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAUREEN KELLY MD (OWNER/PHYSICIAN)
(248) 451-0600
Entity
Organization
Contact information
Practice address
43205 WOODWARD AVE, BLOOMFIELD HILLS, MI 48302-5006
(248) 451-0600
(248) 451-0700
Mailing address
PO BOX 44047, DETROIT, MI 48244-0047
(248) 451-0600
(248) 451-0700
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4301056543
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015775
HEALTH ADVANTAGE
MI
05
—
104183802
—
MI
05
—
1700884814
—
MI
01
—
350F302120
BC GROUP
MI
Enumeration date
07/12/2005
Last updated
06/24/2010
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