Individual
LARRY S KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1575 CONCENTRIC BLVD STE 1, SAGINAW, MI 48604-9312
(989) 583-6800
(989) 583-6915
Mailing address
1000 HOUGHTON AVE, SAGINAW, MI 48602-5303
(989) 583-6800
(989) 583-6915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3788
AK
207Q00000X
Family Medicine Physician
Primary
4301022734
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
381870664
TAX ID
MI
01
—
LK022734
LICENSE
MI
05
—
MD7303
—
AK
Enumeration date
06/01/2006
Last updated
07/21/2022
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