Individual
DR. KEVIN JAMES KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8145 VALLEYWOOD LN, SUITE B, PORTAGE, MI 49024-5296
(269) 324-9162
Mailing address
8145 VALLEYWOOD LN, SUITE B, PORTAGE, MI 49024-5296
(269) 324-9162
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301039833
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103900222
BLUE CROSS BLUE SHIELD OF
MI
Enumeration date
04/18/2006
Last updated
07/09/2007
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