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General NPI Number Information
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NPI Number | 1144452038
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Entity Type | Organization
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Legal Business Name | KELLEY MAHAR MD PC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 109 S FRONT ST SUITE 210
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City | MARQUETTE
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State | MI
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Zip | 49855-4645
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Country | US
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Telephone | 906-228-9100
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Fax | 906-228-2723
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Provider Business Mailing Address
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Address Line | 109 S FRONT ST SUITE 210
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City | MARQUETTE
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State | MI
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Zip | 49855-4645
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Country | US
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Telephone | 906-228-9100
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Fax | 906-228-2723
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KELLEY ANNE MAHAR
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Credential | M.D.
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Telephone | 906-228-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801066478
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301073735
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License Number State | MI
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