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Individual

MICHAEL J KELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
150 SEVENTH AVE STE 200, CHARDON, OH 44024-2909
(440) 285-4999
(402) 855-8704
Mailing address
6480 HARRISON AVE STE 201, CINCINNATI, OH 45247-7961
(440) 285-4999
(440) 285-5870

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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