Individual
FREDERICK JAY KELLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
602 MICHIGAN AVE, HOLLAND, MI 49423
(616) 392-5141
Mailing address
3264 N EVERGREEN DR NE, STE 101, GRAND RAPIDS, MI 49525
(616) 363-7272
(616) 363-7290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301071423
MI
Other
Enumeration date
07/20/2006
Last updated
07/12/2007
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