Individual
MICHAEL JOHN KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101274514
VA
2085R0202X
Diagnostic Radiology Physician
20717
SC
2085R0202X
Diagnostic Radiology Physician
31847
NC
2085R0202X
Diagnostic Radiology Physician
C38560
CA
2085R0204X
Vascular & Interventional Radiology Physician
20717
SC
2085R0204X
Vascular & Interventional Radiology Physician
31847
NC
2085R0204X
Vascular & Interventional Radiology Physician
C38560
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8948125
—
NC
05
—
N31847
—
SC
01
—
NC 300096436
RR MEDICARE NC
NC
01
—
SC 300109599
RR MEDICARE SC
SC
Enumeration date
06/30/2005
Last updated
01/09/2023
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