Kelly M Hefferon DO PC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

KELLY M HEFFERON DO PC

Practice address

5114 Shenandoah CT
W Bloomfield, MI 48323-2343

Phone

(248) 230-1780

NPI assigned

Apr 27, 2015

Last updated

Oct 15, 2015By 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. Kelly M Hefferon, D.O.

Title

Director

Phone

(248) 230-1780

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1518354745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5114 SHENANDOAH CT",
            "city": "W BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232343",
            "telephone_number": "248-230-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5114 SHENANDOAH CT",
            "city": "W BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232343",
            "telephone_number": "248-230-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY M HEFFERON DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "HEFFERON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "248-230-1780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in W Bloomfield, MI
• Providers in W Bloomfield, MI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; 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.