1700884814

Everything you always wanted to know about MAUREEN A KELLY MD PLLC 3 BLOOMFIELD PEDIATRIC CARE DR. KELLY MAUREEN but were afraid to ask.

MAUREEN A KELLY MD PLLC 3 BLOOMFIELD PEDIATRIC CARE DR. KELLY MAUREEN

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Organization Name Other Organization Name Type Code Other Organization Name Authorized Official Prefix Authorized Official Last Name Authorized Official First Name
MAUREEN A KELLY MD PLLC 3 BLOOMFIELD PEDIATRIC CARE DR. KELLY MAUREEN
Gender:
none
Enumeration date:
2005-07-12
Last update date:
2010-06-24
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No

Identifiers

identifier description issuer state
104183802 Medicaid none MI
1700884814 Medicaid none MI
350F302120 Other BCN GROUP MI
350F302120 Other BC GROUP MI
1015775 Other HEALTH ADVANTAGE MI

Taxonomies

Taxonomy State License Number Primary?
2080A0000X Adolescent Medicine MI 4301056543

Phone Numbers

Type Number
Mailing Address Telephone Number 2484510600
Practice Location Address Telephone Number 2484510600
Authorized Official Telephone Number 2484510600
Mailing Address Fax Number 2484510700
Practice Location Address Fax Number 2484510700

Addresses

Type Address City State Postal Country
Mailing Address PO BOX 44047 DETROIT MI 48244 MI
Practice Location Address 43205 WOODWARD AVE BLOOMFIELD HILLS MI 0 MI

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1174521538 RAO, SHEILA
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43205 WOODWARD AVE MI BLOOMFIELD HILLS
1295743920 FOX, IAN
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43205 WOODWARD AVE MI BLOOMFIELD HILLS
1437157955 EARLES, SONJA
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43205 WOODWARD AVE MI BLOOMFIELD HILLS
1609874064 KELLY, MAUREEN
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43205 WOODWARD AVE MI BLOOMFIELD HILLS
1710199864 CASTRO, JENNIFER
Individual
43205 WOODWARD AVE MI BLOOMFIELD HILLS

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3499 S LINDEN RD MI FLINT
1629220231 TUSHAR N RAIJI MD PC
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1740289487 ABBOTT, VALERIE
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1770641078 AHMAD, NAILA
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