NPIMap

Organization Active NPI

Kristopher J. Kelly LLC

  • Specialist
  • Maumee, OH
National Provider Identifier
1083973903
Registry record updated May 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
35087489 Issued in OH
Legal business name
KRISTOPHER J. KELLY LLC
Practice address
5655 Monclova Rd
Maumee, OH 43537-1870
Phone
(419) 893-4883
Fax
(419) 893-2312
NPI assigned
May 12, 2012
Last updated
May 12, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kristopher J Kelly, M.D.NPI 1316980329
Title
Owner
Phone
(419) 893-4883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 35087489 OH Primary

Addresses

Primary practice location

5655 Monclova Rd
Maumee, OH 43537-1870

Mailing address

5655 Monclova Rd
Maumee, OH 43537-1870
Phone (419) 893-4883

National Provider Directory

National Provider Directory

Locations

5655 Monclova Rd
Ste 2
Maumee, OH 43537

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336780800000",
    "number": "1083973903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5655 MONCLOVA RD",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371870",
            "telephone_number": "419-893-4883",
            "fax_number": "419-893-2312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 MONCLOVA RD",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371870",
            "telephone_number": "419-893-4883",
            "fax_number": "419-893-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTOPHER J. KELLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-12",
        "last_updated": "2012-05-12",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-893-4883",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "35087489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.