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General NPI Number Information
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NPI Number | 1649343278
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1708 YAKIMA AVE STE 300
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City | TACOMA
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State | WA
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Zip | 98405-5309
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Country | US
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Telephone | 253-363-8700
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Fax | 360-782-3115
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Provider Business Mailing Address
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Address Line | 1708 YAKIMA AVE STE 300
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City | TACOMA
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State | WA
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Zip | 98405-5309
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Country | US
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Telephone | 253-363-8700
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Fax | 360-782-3115
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00033879
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD00033879
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD00033879
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License Number State | WA
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