Healthcare Provider Details

I. General information

NPI: 1619909793
Provider Name (Legal Business Name): DENNIS G KELLY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD SUITE 303A
MADISON HEIGHTS MI
48071-3491
US

IV. Provider business mailing address

27483 DEQUINDRE SUITE 303A
MADISON HGTS MI
48071
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-4614
  • Fax: 248-398-4345
Mailing address:
  • Phone: 248-398-4614
  • Fax: 248-398-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDK008799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: