MEDICARE: DR. MICHAEL D KELLY D.O., MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	N4515	TX
2	207VX0000X	Obstetrics Physician	N4515	TX
3	207V00000X	Obstetrics & Gynecology Physician	N4515	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023124385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D KELLY D.O., MBA

Provider Business Mailing Address
First Line	:	1125 CYPRESS STATION DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	832-602-2030
Fax Number	:	281-205-4659

Provider Business Practice Location Address
First Line	:	1125 CYPRESS STATION DR STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3055
Country	:	US
Telephone Number	:	832-602-2030
Fax Number	:	281-205-4659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	03/24/2023

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Directions to “ DR. MICHAEL D KELLY D.O., MBA” Practice Location

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