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General NPI Number Information
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NPI Number | 1285059113
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Entity Type | Individual
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Provider Name | BENJAMIN MICHAEL KELLEY DO
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Gender | Male
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 701 MANATEE AVE W STE 202
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City | BRADENTON
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State | FL
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Zip | 34205-8624
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Country | US
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Telephone | 941-748-2455
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Fax | 941-746-4554
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Provider Business Mailing Address
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Address Line | 701 MANATEE AVE W STE 202
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City | BRADENTON
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State | FL
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Zip | 34205-8624
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Country | US
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Telephone | 941-748-2455
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Fax | 941-746-4554
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | OS15670
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License Number State | FL
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