Healthcare Provider Details

I. General information

NPI: 1306831243
Provider Name (Legal Business Name): FRANK J. KELLY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIVLEY RD SW SUITE 620
HUNTSVILLE AL
35801-5134
US

IV. Provider business mailing address

PO BOX 2705 STE 220
HUNTSVILLE AL
35804-2705
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-4600
  • Fax: 256-265-4651
Mailing address:
  • Phone: 256-801-6048
  • Fax: 256-801-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number00019355
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: