Individual
DR. KATHLEEN MARIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2325 SUMMIT PARK DR, SUITE B, PETOSKEY, MI 49770-8774
(231) 347-1800
(231) 347-1864
Mailing address
1101 N US HIGHWAY 31, PETOSKEY, MI 49770-9305
(231) 489-1006
(231) 753-3039
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1601000052
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540B410790
BCBS HEARING PROVIDER ID
MI
01
—
640B410780
BCBS AUDIOLOGYPROVIDER ID
MI
Enumeration date
06/15/2006
Last updated
08/15/2017
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