Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD00012273 | WA |
NPI | 1013903780 |
---|---|
Provider Name | Michael R Kelly |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 23/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0240674 | L&I (01) | WA |
390000492 | RR MEDICARE (01) | WA |
78911 | LE (01) | WA |
A04872 | (02) | |
MD7023 | ALASKA DSHS (01) | WA |