Individual
MICHAEL JOHN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-1303
(253) 982-7084
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(253) 982-7084
(253) 968-3278
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26546
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930712715
TAX ID#
—
Enumeration date
01/25/2006
Last updated
03/13/2019
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