Healthcare Provider Details

I. General information

NPI: 1730130584
Provider Name (Legal Business Name): MICHAEL E KELLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 EUCLID AVE
CLEVELAND OH
44195-1063
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5517
  • Fax: 216-444-3577
Mailing address:
  • Phone: 216-444-5517
  • Fax: 216-444-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35.131181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: