Kevin J. Kelly MD, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

039833 Issued in MI

Legal business name

KEVIN J. KELLY MD, PC

Practice address

8145 Valleywood LN Ste B
Portage, MI 49024-5296

Phone

(269) 324-9162

Fax

(269) 375-6079

NPI assigned

Sep 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kevin J Kelly, MD

Title

Owner

Phone

(269) 324-9162

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1188691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188691200000",
    "number": "1689868697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8145 VALLEYWOOD LN STE B",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245296",
            "telephone_number": "269-324-9162",
            "fax_number": "269-375-6079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8145 VALLEYWOOD LN STE B",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245296",
            "telephone_number": "269-324-9162",
            "fax_number": "269-375-6079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN J. KELLY MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-02",
        "last_updated": "2007-09-02",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-324-9162",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "039833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0390022",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4282408",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridget Sage Kenny, P.A.-C.
• Jessica A Kerby, PHD
• Keszei Vision Care, PLC
• Vincent Andrew Keszei, M.D.
• Joshua Kettlewell, PT, DPT
• Kid Strides Physical Therapy LLC
• Amber Kidder
• Sheryl Lynn Kiel, MA LLP
• Stanislava Kier, LLPC
• Daniel Kik, HIS

• Internal Medicine Physician in Portage, MI
• Providers in Portage, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2007; 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.