Individual
DR. JOHN JOSEPH KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 S EVANS ST, TECUMSEH, MI 49286-1949
(517) 423-9300
(517) 423-9400
Mailing address
115 S EVANS ST, TECUMSEH, MI 49286-1949
(517) 423-9300
(517) 423-9400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301057968
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0804610981
BCBS
MI
01
—
4301057968
STATE LICENSE
MI
Enumeration date
11/03/2005
Last updated
10/18/2011
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