Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301066091 | MI |
NPI | 1013951953 |
---|---|
Provider Name | Dr. Julie L Henry-Kelly |
First Address | Warren, MI 48088-4729 |
Second Address | Warren, MI 48088-4729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 10/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4492165 | (05) | MI |
4876080001 | NATL SUPPLIER CLEARINGHOU (01) | MI |
G76233 | (02) | MI |