MAUREEN A KELLY MD PLLC NPI 1700884814

NPI Information

NPI: 1700884814
Provider Name: MAUREEN A KELLY MD PLLC

Doing Business As: BLOOMFIELD PEDIATRIC CARE

Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
43205 WOODWARD AVE
BLOOMFIELD HILLS, MI
ZIP 48302
Phone: (248) 451-0600
Get Directions

MAUREEN A KELLY MD PLLC is an adolescent medicine pediatrics in Bloomfield Hills, MI. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. MAUREEN A KELLY MD PLLC NPI is 1700884814. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Bloomfield Pediatric Care.

The provider's business location address is:

43205 WOODWARD AVE
BLOOMFIELD HILLS, MI
ZIP 48302-006
Phone: (248) 451-0600
Fax: (248) 451-0700

The provider's authorized official is Maureen Kelly .
The authorized official title is Owner/physician and has the following contact phone number (248) 451-0600.

The enumeration date for this NPI number is 7/12/2005 and was last updated on 6/24/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	4301056543	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	104183802	MEDICAID	MICHIGAN
2	1700884814	MEDICAID	MICHIGAN
3	350F302120	OTHER	MICHIGAN	BCN GROUP
4	350F302120	OTHER	MICHIGAN	BC GROUP
5	1015775	OTHER	MICHIGAN	HEALTH ADVANTAGE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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