Individual
MICHAEL J KELLIS
Active
Individual
MICHAEL J KELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
34004183
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0658051
—
OH
01
—
139662
ANTHEM
OH
01
—
250006704
RR MEDICARE
OH
01
—
4073792
AETNA
OH
Enumeration date
08/09/2005
Last updated
11/02/2023
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