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1437146370

NPI Code Detail

MEDICARE: JOHN M KELLY MD

MEDICARE: JOHN M KELLY MD

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	P3014	TX
2	208M00000X	Hospitalist Physician	P3014	TX
3	207R00000X	Internal Medicine Physician	MD2007-0514	NM

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	:	1437146370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M KELLY MD

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR STE 1.100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-338-6353
Fax Number	:	713-704-3086

Provider Business Practice Location Address
First Line	:	1635 NORTH LOOP W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1532
Country	:	US
Telephone Number	:	713-867-2066
Fax Number	:

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	03/21/2020

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Directions to “ JOHN M KELLY MD” Practice Location

Language	Start Address	Practice Location

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