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Individual

DR. MICHAEL JOSEPH KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1708 YAKIMA AVE STE 300, TACOMA, WA 98405-5309
(253) 363-8700
(360) 782-3115
Mailing address
1708 YAKIMA AVE STE 300, TACOMA, WA 98405-5309
(253) 363-8700
(360) 782-3115

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00033879
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00033879
WA
208M00000X
Hospitalist Physician
MD00033879
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0125746
STATE L&I
WA
01
0280978
L&I
WA
05
1045078
WA
05
8193823
WA
01
G8901118
MEDICARE
WA
Enumeration date
11/15/2006
Last updated
12/04/2020
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