Individual
SHANE THOMAS KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704329144
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704329144
MI
Other
Enumeration date
05/23/2023
Last updated
04/23/2026
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