MEDICARE: DR. GINA M KELLY D.O , MS

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	208D00000X	General Practice Physician	34.016941	OH

General Provider Information

NPI Number	:	1366947715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA M KELLY D.O , MS

Provider Business Mailing Address
First Line	:	PO BOX 26066
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44126-0066
Country	:	US
Telephone Number	:	816-786-1917
Fax Number	:

Provider Business Practice Location Address
First Line	:	23790 ELM RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3726
Country	:	US
Telephone Number	:	816-786-1917
Fax Number	:

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

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	09/21/2024

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