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General NPI Number Information
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NPI Number | 1467745935
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Entity Type | Individual
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Provider Name | WILLIAM MICHAEL KELLEY R.C.E.P.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 400 CELEBRATION PL 400 CELEBRATION PLACE
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City | CELEBRATION
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State | FL
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Zip | 34747-4970
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Country | US
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Telephone | 407-644-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 2534 CROWN RIDGE CIR
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City | KISSIMMEE
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State | FL
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Zip | 34744-8461
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Country | US
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Telephone | 407-644-1820
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | K400933611220
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License Number State | FL
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