Healthcare Provider Details

I. General information

NPI: 1750635769
Provider Name (Legal Business Name): KELLY & WOLF MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 903E
MIAMI FL
33176-2176
US

IV. Provider business mailing address

8940 N KENDALL DR STE 903E
MIAMI FL
33176-2176
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-2969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E KELLY
Title or Position: OWNER
Credential:
Phone: 305-595-2969