Individual
MEGHAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2513 MOMENTUM PL, CHICAGO, IL 60689
(231) 935-6080
(231) 935-6081
Mailing address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-2170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/14/2016
Last updated
08/20/2018
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