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MR. MICHAEL C KELLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
PO BOX 12749, COVINGTON, KY 41012-0749
(859) 341-7246
(859) 341-7867

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
136201
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
028218
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000373372
ANTHEM
OH
01
000000555281
ANTHEM
05
0798892
OH
05
200304960
IN
05
74282187
KY
01
9318802
PHCS
01
P00261495
RAILROAD MEDICARE PALMETT
OH
Enumeration date
04/28/2006
Last updated
05/01/2008
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