Individual
MARY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28311 FRANKLIN RD APT C339, SOUTHFIELD, MI 48034-5556
(248) 632-9211
Mailing address
28311 FRANKLIN RD APT C339, SOUTHFIELD, MI 48034-5556
(248) 632-9211
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
268759
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H60218395
HUMANA
MI
01
—
H60218395
HUMANA
—
Enumeration date
02/27/2023
Last updated
02/27/2023
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