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NPI Code Detail

MEDICARE: DR. MICHAEL T KELLY MD

MEDICARE: DR. MICHAEL T 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
1207Q00000XFamily Medicine Physician12715OK

General Provider Information

NPI Number : 1518936152
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL T KELLY MD
Provider Business Mailing Address
First Line : 1202 W FARM RD
Second Line :
City : STILLWATER
State : OK
Zip : 74078-2000
Country : US
Telephone Number : 405-744-7665
Fax Number : 405-744-6556
Provider Business Practice Location Address
First Line : 1202 W FARM RD
Second Line :
City : STILLWATER
State : OK
Zip : 74078-2000
Country : US
Telephone Number : 405-744-7665
Fax Number : 405-744-6556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MICHAEL T KELLY MD” Practice Location

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