Individual
MICHAEL D KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6665
(937) 395-6668
Mailing address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6665
(937) 395-6668
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50003217
OH
363AS0400X
Surgical Physician Assistant
50003217
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085230
—
OH
Enumeration date
02/13/2006
Last updated
01/20/2021
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