# DENNIS G KELLY DO PC

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

## Provider details

- **NPI number:** 1740543222
- **Authorized official:** MS. CHRISTA J SHARP (MANAGER)
- **Authorized official phone:** (248) 398-4614

## Contact information

- **Practice address:** 1431 E 12 MILE RD, BLDG C, MADISON HEIGHTS, MI 48071-2653
- **Practice address phone:** (248) 398-4614
- **Practice address fax:** (248) 398-4345
- **Mailing address:** 1431 E 12 MILE RD, BLDG C, MADISON HEIGHTS, MI 48071-2653
- **Mailing address phone:** (248) 398-4614
- **Mailing address fax:** (248) 398-4345

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | DK008799 | MI | Yes |

## Other

- **Enumeration date:** 06/20/2012
- **Last updated:** 06/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2727880 TYPE 11 | — | MI |