Organization
DENNIS G KELLY DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTA J SHARP (MANAGER)
(248) 398-4614
Entity
Organization
Contact information
Practice address
1431 E 12 MILE RD, BLDG C, MADISON HEIGHTS, MI 48071-2653
(248) 398-4614
(248) 398-4345
Mailing address
1431 E 12 MILE RD, BLDG C, MADISON HEIGHTS, MI 48071-2653
(248) 398-4614
(248) 398-4345
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
DK008799
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2727880 TYPE 11
—
MI
Enumeration date
06/20/2012
Last updated
06/20/2012
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