Healthcare Provider Details

I. General information

NPI: 1659619807
Provider Name (Legal Business Name): KELLY WOLF & HERMAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 902E
MIAMI FL
33176-2176
US

IV. Provider business mailing address

8940 N KENDALL DR STE 902E
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

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