MEDICARE: JANICE MARIE KELLEY M.D.

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	207R00000X	Internal Medicine Physician	F6814	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D1015567	OTHER	TN	CLIA WAIVER
2	8J5580	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1346347978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE MARIE KELLEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 90639
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77290-0639
Country	:	US
Telephone Number	:	281-970-6089
Fax Number	:	281-970-6105

Provider Business Practice Location Address
First Line	:	13323 DOTSON RD STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4303
Country	:	US
Telephone Number	:	281-970-6089
Fax Number	:	281-970-6105

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	03/19/2008

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