MEDICARE: PATRICIA E KELLY 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	4301034349	MI

General Provider Information

NPI Number	:	1467477091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA E KELLY M.D.

Provider Business Mailing Address
First Line	:	2340 E STADIUM BLVD STE 5
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-995-5982
Fax Number	:	734-995-9659

Provider Business Practice Location Address
First Line	:	2340 E STADIUM BLVD STE 5
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-995-5982
Fax Number	:	734-995-9659

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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