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NPI Code Detail

MEDICARE: KATIE KELLEY MD, MPH

MEDICARE: KATIE KELLEY MD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207QA0401XAddiction Medicine (Family Medicine) Physician35.144090OH

General Provider Information

NPI Number : 1043847510
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE KELLEY MD, MPH
Provider Business Mailing Address
First Line : 2500 METROHEALTH DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1900
Country : US
Telephone Number : 216-778-4486
Fax Number :
Provider Business Practice Location Address
First Line : 2500 METROHEALTH DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1900
Country : US
Telephone Number : 216-778-4486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2020
Last Update Date : 09/26/2023

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