Organization
KEVIN J. KELLY MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN J KELLY MD (OWNER)
(269) 324-9162
Entity
Organization
Contact information
Practice address
8145 VALLEYWOOD LN STE B, PORTAGE, MI 49024-5296
(269) 324-9162
(269) 375-6079
Mailing address
8145 VALLEYWOOD LN STE B, PORTAGE, MI 49024-5296
(269) 324-9162
(269) 375-6079
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039833
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0390022
BCBSM
MI
05
—
4282408
—
MI
Enumeration date
09/02/2007
Last updated
09/02/2007
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