Larry S Kelly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301022734 Issued in MI

Practice address

1575 Concentric Blvd Ste 1
Saginaw, MI 48604-9312

Phone

(989) 583-6800

Fax

(989) 583-6915

NPI assigned

Jun 1, 2006

Last updated

Jul 21, 2022By 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 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Michigan Cardiovascular Institute, PC

  • Cardiovascular Disease Physician
  • Saginaw, MI
  • NPI 1023098191
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508803149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HOUGHTON AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486025303",
            "telephone_number": "989-583-6800",
            "fax_number": "989-583-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 CONCENTRIC BLVD STE 1",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486049312",
            "telephone_number": "989-583-6800",
            "fax_number": "989-583-6915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LARRY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "3788",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301022734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD7303",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "381870664",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "LK022734",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Lewis, LMSW,MSW
• Amber Kelly, LLMSW
• Jeffrey Alan Kelly, D.C.
• John Michael Kelly, D.C.
• Kimberly Ann Kelly, OTR
• Tina Marie Kelly, RDH
• Andre R Kemp, LLMSW
• Anjanette Dorothy Kemp, DO
• Grace Ann Kemp, LLBSW
• Nava Kendall, M.D.

• Family Medicine Physician in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.