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NPI Code Detail

MEDICARE: KELLY M ELIE

MEDICARE:   KELLY M ELIE
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
1171W00000XContractor

General Provider Information

NPI Number : 1386336808
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M ELIE
Provider Business Mailing Address
First Line : 377 E 214TH ST
Second Line :
City : EUCLID
State : OH
Zip : 44123-1950
Country : US
Telephone Number : 216-394-4223
Fax Number :
Provider Business Practice Location Address
First Line : 377 E 214TH ST
Second Line :
City : EUCLID
State : OH
Zip : 44123-1950
Country : US
Telephone Number : 216-394-4223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2023
Last Update Date : 05/23/2023

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Directions to “ KELLY M ELIE ” Practice Location

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