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General NPI Number Information
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NPI Number | 1922115070
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 9430 PARK WEST BLVD STE 310
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City | KNOXVILLE
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State | TN
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Zip | 37923-4203
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Country | US
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Telephone | 865-690-5263
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Fax | 865-588-3740
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Provider Business Mailing Address
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Address Line | PO BOX 52948
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City | KNOXVILLE
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State | TN
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Zip | 37950-2948
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Country | US
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Telephone | 865-306-5675
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Fax | 865-584-7712
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD34159
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License Number State | TN
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