Dennis G Kelly DO PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

DK008799 Issued in MI

Legal business name

DENNIS G KELLY DO PC

Practice address

1431 E 12 Mile Rd
BLDG C
Madison Heights, MI 48071-2653

Phone

(248) 398-4614

Fax

(248) 398-4345

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Christa J Sharp

Title

Manager

Phone

(248) 398-4614

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1740543222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 E 12 MILE RD",
            "address_2": "BLDG C",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480712653",
            "telephone_number": "248-398-4614",
            "fax_number": "248-398-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 E 12 MILE RD",
            "address_2": "BLDG C",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480712653",
            "telephone_number": "248-398-4614",
            "fax_number": "248-398-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS G KELLY DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-398-4614",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MI",
            "license": "DK008799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2727880 TYPE 11",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asilis Jose Defran, MD
• Jinane Degheim
• Megan Delmonte, PA-C
• Tammy Demeere, DPT
• Andrea Demeester, MOT, OTRL
• Jordan J Dennis, RBT
• Colleen Denver
• Stephanie Lauren Dillof, RD
• Direct DME, Inc.
• Doreen Marie Disanto I, OTRL

• Medical Specialty Clinic/Center in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• Medical Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.