Brian G Kelly, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4301044066 Issued in MI

Practice address

25959 Kelly Road
Suite B
Roseville, MI 48066

Phone

(586) 773-9510

Fax

(586) 773-6888

NPI assigned

Aug 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: bkelly222558@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeshore Osteopathic Center,P.C.

  • Neuromusculoskeletal Medicine & OMM Physician
  • Grosse Pointe Woods, MI
  • NPI 1932238052
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396857892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25959 KELLY ROAD",
            "address_2": "SUITE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-773-9510",
            "fax_number": "586-773-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25959 KELLY ROAD",
            "address_2": "SUITE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "48066",
            "telephone_number": "586-773-9510",
            "fax_number": "586-773-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "BRIAN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301044066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2884854",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wojciech D Kasprowicz, PT
• Joseph Kassa, D.O.
• Christine Keller, M.A., L.L.P.
• Kelly Otp LLC
• Kelly Road Dentistry PLLC
• Emily A Kempton
• Apostolos George Kerasiotis, D.P.T.
• Kerri S. Gustafson, DDS, PLLC, Dentistry for Children
• Keshinudan Inc. (Eastpointe Pharmacy)
• Quresh Khairullah, MD

• Obstetrics & Gynecology Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.