NPIMap

Individual provider Active NPI

Michael Kelly, MD

  • Clinical Pathology/Laboratory Medicine Physician
  • Ferndale, MI
National Provider Identifier
1912981010
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
License
86418 Issued in WI
Practice address
1933 Hyland St
Ferndale, MI 48220-3803
Phone
(248) 933-0558
NPI assigned
Dec 1, 2005
Last updated
Mar 20, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301065795 MI
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 86418 WI Primary

Addresses

Primary practice location

1933 Hyland St
Ferndale, MI 48220-3803

Mailing address

1933 Hyland St
Ferndale, MI 48220-3803

Other identifiers 2

IdentifierTypeStateIssuer
BLUE CROSSOtherMI340H275000
COMMERICALOtherMI382032989

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081118000620 MI Practitioner - Pathology 0547320764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Wayne State University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Langston Walker and Associates, P.C.Group PAC ID 1456443670, 5 clinicians
Legacy Path LLCGroup PAC ID 5890237960, 16 clinicians

Practice addresses (Care Compare)

11800 E 12 Mile Rd
Langston Walker P.C.
Warren, MI 48093-3472
Phone (586) 573-5020

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-7231

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301065795MIMDAnatomic Pathology & Clinical Pathology Physician
86418WIMDClinical Pathology/Laboratory Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 6, 2025 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Oct 6, 2025 Accepting new patients

Locations

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

Interoperability endpoints

  • Direct secure messaging: mkelly1134405@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773964800000",
    "number": "1912981010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 HYLAND ST",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482203803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 HYLAND ST",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482203803",
            "telephone_number": "248-933-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301065795",
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "WI",
            "license": "86418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "340H275000",
            "identifier": "BLUE CROSS",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "382032989",
            "identifier": "COMMERICAL",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ferndale, MI

Sources for this page

Verify at the official NPI Registry.