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General NPI Number Information
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NPI Number | 1831190313
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Entity Type | Individual
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Provider Name | MICHAEL J KELLIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 150 SEVENTH AVE STE 200
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City | CHARDON
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State | OH
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Zip | 44024-2909
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Country | US
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Telephone | 440-285-4999
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Fax | 402-855-8704
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Provider Business Mailing Address
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Address Line | 6480 HARRISON AVE STE 201
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City | CINCINNATI
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State | OH
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Zip | 45247-7961
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Country | US
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Telephone | 440-285-4999
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Fax | 440-285-5870
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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 | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 34004183
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License Number State | OH
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