Christopher B Kelly MD PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

CK055724 Issued in MI

Legal business name

CHRISTOPHER B KELLY MD PC

Practice address

1066 N Monroe St
Monroe, MI 48162-3113

Phone

(734) 243-6640

Fax

(734) 243-6643

NPI assigned

Apr 22, 2008

Last updated

Apr 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher B Kelly, M.D.

Title

Owner

Phone

(734) 243-6640

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1255505111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1066 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623113",
            "telephone_number": "734-243-6640",
            "fax_number": "734-243-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 N MONROE ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623113",
            "telephone_number": "734-243-6640",
            "fax_number": "734-243-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOPHER B KELLY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-243-6640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "CK055724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2849194",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Monroe, MI
• Providers in Monroe, MI by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.