MEDICARE: DR. GEORGE JOHN KELEN M.D., F.A.C.C.

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
1	246X00000X	Cardiovascular Specialist/Technologist	4301079843	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA9989	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548255128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JOHN KELEN M.D., F.A.C.C.

Provider Business Mailing Address
First Line	:	102 E LUDINGTON AVE
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-2191
Country	:	US
Telephone Number	:	231-425-4590
Fax Number	:	231-425-4588

Provider Business Practice Location Address
First Line	:	102 E LUDINGTON AVE
Second Line	:
City	:	LUDINGTON
State	:	MI
Zip	:	49431-2191
Country	:	US
Telephone Number	:	231-425-4590
Fax Number	:	231-425-4588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	06/09/2014

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