Individual
CONRAD JOSEPH KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236
(313) 343-4000
Mailing address
2455 CULBERTSON AVE, ROCHESTER HILLS, MI 48307-4609
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704293196
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704293196
MI
Other
Enumeration date
07/20/2017
Last updated
07/26/2018
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