Healthcare Provider Details

I. General information

NPI: 1144906322
Provider Name (Legal Business Name): BRANDELYN RACHAEL KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER HILLS MI
48307-1863
US

IV. Provider business mailing address

1135 W UNIVERSITY DR
ROCHESTER HILLS MI
48307-1871
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4900
  • Fax:
Mailing address:
  • Phone: 248-650-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351051280
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: