Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 4301101907 | MI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301101907 | MI |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 4301101907 | MI |
NPI | 1205189669 |
---|---|
Provider Name | Dr. Adrienne Margaret Kelly |
First Address | Gaylord, MI 49735-1595 |
Second Address | Gaylord, MI 49735-0003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2012 |
Last Update Date | 03/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OF96004 | MEDICARE GROUP NUMBER (01) |