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General NPI Number Information
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NPI Number | 1750635769
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Entity Type | Organization
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Legal Business Name | KELLY & WOLF MD PA
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 8940 N KENDALL DR STE 903E
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City | MIAMI
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State | FL
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Zip | 33176-2176
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Country | US
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Telephone | 305-595-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 8940 N KENDALL DR STE 903E
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City | MIAMI
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State | FL
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Zip | 33176-2176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL E KELLY
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Credential |
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Telephone | 305-595-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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