Individual
DR. MICHAEL JOSEPH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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