Individual
JOHN KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
24500 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-2414
(248) 353-1280
(248) 353-6193
Mailing address
24500 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-2414
(248) 353-1280
(248) 353-6193
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5101006257
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205209
—
MI
Enumeration date
07/17/2006
Last updated
08/20/2007
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