MEDICARE: DR. CHARLES E KELLY D.O.

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	207RG0100X	Gastroenterology Physician	CK006922	MI

General Provider Information

NPI Number	:	1881698629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E KELLY D.O.

Provider Business Mailing Address
First Line	:	820 BYRON RD
Second Line	:	STE 200
City	:	HOWELL
State	:	MI
Zip	:	48843-1024
Country	:	US
Telephone Number	:	517-548-1246
Fax Number	:	517-548-9164

Provider Business Practice Location Address
First Line	:	820 BYRON RD
Second Line	:	STE 200
City	:	HOWELL
State	:	MI
Zip	:	48843-1024
Country	:	US
Telephone Number	:	517-548-1246
Fax Number	:	517-548-9164

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. CHARLES E KELLY D.O.” Practice Location

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