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1598071201 NPI number — THOMAS KELLY

NPI Number: 1598071201
Health Care Provider/Practitioner: THOMAS KELLY

Information about “1598071201” NPI (THOMAS KELLY) exists in 1598071201 in HTML format HTML  |  1598071201 in plain Text format TXT  |  1598071201 in PDF (Portable Document Format) PDF  |  1598071201 in an XML format XML  formats.

NPI Number : 1598071201 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598071201",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KELLY",
    "FirstName": "THOMAS",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1025 MOREHEAD MEDICAL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28204-2963",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "850 W BARAGA AVE STE 32",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARQUETTE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49855-4550",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "906-449-3680",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/19/2010",
    "LastUpdateDate": "01/13/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "4301500343",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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