Healthcare Provider Details

I. General information

NPI: 1518253418
Provider Name (Legal Business Name): MICHAEL S KELLEHER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST STE 700
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

17921 VILLA CLUB WAY
BOCA RATON FL
33496-1000
US

V. Phone/Fax

Practice location:
  • Phone: 740-504-9671
  • Fax:
Mailing address:
  • Phone: 860-620-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number54974
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number54974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: