Organization
MICHAEL J. KELLY MD
Active
Organization
MICHAEL J. KELLY MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J KELLY MD (OWNER)
(860) 435-3551
Entity
Organization
Contact information
Practice address
308 MAIN ST, LAKEVILLE, CT 06039-1204
(860) 435-3551
(860) 435-3561
Mailing address
PO BOX 1748, LAKEVILLE, CT 06039-1748
(860) 435-3551
(860) 435-3561
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
041727
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001417270
—
CT
01
—
1124102546
NPI
—
Enumeration date
06/10/2008
Last updated
06/10/2008
Update your record
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