MEDICARE: BRIAN M KELLY DO

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	2081P0004X	Spinal Cord Injury Medicine Physician	5101013044	MI
2	208100000X	Physical Medicine & Rehabilitation Physician	5101013044	MI

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	:	1073695953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN M KELLY DO

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 S INDUSTRIAL HWY STE 400
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6796
Country	:	US
Telephone Number	:	734-973-2400
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	06/16/2020

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Directions to “ BRIAN M KELLY DO” Practice Location

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