Individual
KIM MICHELLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12710 SE DIVISION STREET, PORTLAND, OR 97236
(503) 988-3601
Mailing address
421 SW OAK ST., #210, PORTLAND, OR 97204
(503) 988-3663
(503) 988-4098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47017
MN
Other
Enumeration date
07/25/2006
Last updated
03/07/2023
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