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General NPI Number Information
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NPI Number | 1205189669
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Entity Type | Individual
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Provider Name | ADRIENNE MARGARET KELLY MD
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Gender | Female
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 2147 PROFESSIONAL DR
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City | GAYLORD
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State | MI
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Zip | 49735-0003
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Country | US
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Telephone | 989-732-1753
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Fax | 989-731-1425
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Provider Business Mailing Address
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Address Line | 829 N CENTER AVE SUITE 298
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City | GAYLORD
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State | MI
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Zip | 49735-1595
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Country | US
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Telephone | 989-731-7708
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Fax | 989-731-7929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 4301101907
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 4301101907
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 4301101907
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License Number State | MI
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