Organization
GEAUGA SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J KELIS D.O. (PRESIDENT)
(440) 285-6452
Entity
Organization
Contact information
Practice address
13207 RAVENNA RD, CHARDON, OH 44024-7032
(440) 285-6452
(440) 285-1796
Mailing address
PO BOX 567, CHAGRIN FALLS, OH 44022-0567
(216) 464-5160
(216) 464-5982
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250006704
RR MEDICARE
OH
Enumeration date
08/09/2005
Last updated
07/21/2022
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