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NPI Code Detail

MEDICARE: KELLY M BRASH MD

MEDICARE: KELLY M BRASH 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
1207R00000XInternal Medicine Physician4301505278MI

General Provider Information

NPI Number : 1922505007
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M BRASH MD
Provider Business Mailing Address
First Line : 1234 NAPIER AVE
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2112
Country : US
Telephone Number : 269-985-4632
Fax Number :
Provider Business Practice Location Address
First Line : 1234 NAPIER AVE
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2112
Country : US
Telephone Number : 269-985-4632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2018
Last Update Date : 03/03/2026

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