Michael J Kelley DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

5901001533 Issued in MI

Legal business name

MICHAEL J KELLEY DPM

Practice address

6785 Myers Lake Ave NE
Suite C
Rockford, MI 49341-7416

Phone

(616) 874-8772

NPI assigned

Aug 22, 2006

Reactivated

Jan 24, 2008

Organization subpart

No

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

Authorized official

Name

Michael J Kelley, DPM

Title

President

Phone

(616) 874-8772

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1295841153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 LEONARD ST NW",
            "address_2": "SUITE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495348447",
            "telephone_number": "616-453-6329",
            "fax_number": "616-453-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6785 MYERS LAKE AVE NE",
            "address_2": "SUITE C",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417416",
            "telephone_number": "616-874-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J KELLEY DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2012-10-24",
        "deactivation_date": "2008-01-03",
        "reactivation_date": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-874-8772",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901001533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2751473",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason William Meagrow, P.T.
• Meijer Inc
• Alyssia Metheny, BEHAVIOR TECHNICIAN
• Robert Craig Mette, D.D.S.
• Sarah Lynn Meyle, RN
• Emily Michalak
• Michigan Medical Patient Care
• Michigan Nutrigenetics
• Steven Andrew Mikulak, D.C.
• Emily Grace Milan, OTR/L

• Podiatrist in Rockford, MI
• Providers in Rockford, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.