Individual
MICHAEL R KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2420
(206) 744-5939
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD00012273
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0240674
L&I
WA
01
—
390000492
RR MEDICARE
WA
01
—
78911
LE
WA
01
—
MD7023
ALASKA DSHS
WA
Enumeration date
09/27/2005
Last updated
01/23/2012
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