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General NPI Number Information
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NPI Number | 1366947715
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Entity Type | Individual
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Provider Name | GINA M KELLY D.O , MS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 23790 ELM RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3726
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Country | US
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Telephone | 816-786-1917
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26066
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City | CLEVELAND
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State | OH
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Zip | 44126-0066
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Country | US
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Telephone | 816-786-1917
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 34.016941
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License Number State | OH
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