MAUREEN A KELLY MD PLLC (NPI# 1700884814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700884814 |
| Entity Type | Organization |
| Organization Name | MAUREEN A KELLY MD PLLC |
| Other Organization Name | BLOOMFIELD PEDIATRIC CARE |
| Practice Address |
43205 Woodward Ave Bloomfield Hills MI 48302-5006 |
| Mailing Address |
Po Box 44047 Detroit MI 48244-0047 |
| Practice Telephone | 2484510600 |
| Practice Fax Number | 2484510700 |
| Mailing Telephone | 2484510600 |
| Mailing Fax Number | 2484510700 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2010-06-24 |
| Authorized Official Name | DR. MAUREEN KELLY (OWNER/PHYSICIAN) |
| Authorized Official Telephone | 2484510600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
4301056543 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104183802 | 05 | |
| MI | HEALTH ADVANTAGE | 1015775 | 01 |
| MI | 1700884814 | 05 | |
| MI | BC GROUP | 350F302120 | 01 |
| MI | BCN GROUP | 350F302120 | 01 |
| Other Name | Type Code |
|---|---|
| BLOOMFIELD PEDIATRIC CARE | Doing Business As Name - Organization |
| Street Address |
43205 WOODWARD AVE |
| City | BLOOMFIELD HILLS |
| State | MI |
| Zip Code | 48302-5006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437157955 | Sonja M Earles | Pediatrics | 43205 Woodward Ave, Bloomfield Hills, MI 48302-5006 | 2005-07-08 |
| 1275959652 | Kathleen Marie Kochanowicz | Nurse Practitioner | 43205 Woodward Ave, Bloomfield Hills, MI 48302 | 2014-03-10 |
| 1710199864 | Jennifer Gray Castro | Pediatrics | 43205 Woodward Ave, Bloomfield Hills, MI 48302-5006 | 2007-05-03 |
| 1295743920 | Ian Howard Fox | Pediatrics | 43205 Woodward Ave, Bloomfield Hills, MI 48302-5006 | 2006-08-05 |
| 1174521538 | Sheila Rao | Pediatrics | 43205 Woodward Ave, Bloomfield Hills, MI 48302-5006 | 2005-07-11 |
| 1609874064 | Maureen A Kelly | Pediatrics | 43205 Woodward Ave, Bloomfield Hills, MI 48302-5006 | 2005-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386242634 | Lamuriel Lewis | Registered Nurse | 1430 South Telegraph Rd, Bloomfield Hills, MI 48302 | 2020-10-09 |
| 1730794082 | Ola Glezen | Registered Nurse | 1410 South Telegraph Road, Bloomfield Hills, MI 48302 | 2020-09-14 |
| 1114563400 | Henry Ford Health System | Pharmacy | 1961 S Telegraph Rd, Bloomfield Twp, MI 48302 | 2019-11-21 |
| 1508407982 | P-cor LLC | Eyewear Supplier (Equipment, not the service) | 1961 S. Telegraph Rd, Bloomfield Hills, MI 48302 | 2019-10-07 |
| 1144887936 | Christine Beth Wilson De Medina | Psychologist | W-4111 Andover Road, Bloomfield Hills, MI 48302 | 2019-05-28 |
| 1942793799 | Andrew Joseph Grix | Physical Therapist | 2525 S Telegraph Rd Ste 314, Bloomfield Hills, MI 48302 | 2018-06-06 |
| 1306398078 | Shaleene Mayo | Mechanotherapist | 43902 Woodward # 120, Bloomfield Hills, MI 48302 | 2016-10-28 |
| 1588112981 | Carol Van Kampen | Social Worker | 2550 S. Telegraph, Bloomfield Hills, MI 48302 | 2016-09-14 |
| 1770933848 | Rachelle Savalli | Family Medicine | 1961 South Telegraph Rd, Bloomfield Twp, MI 48302 | 2016-06-20 |
| 1699155366 | Aleksey Mishulin | Ophthalmology | 1750 S Telegraph Ste 205, Bloomfield Hills, MI 48302 | 2015-06-08 |
| Find all providers in zip 48302 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457761066 | Susan Raymundo | Pediatrics | 209 Chestnut Cir, Bloomfield Hills, MI 48304-2105 | 2014-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265921191 | Gogue Pediatrics, P.C. | Pediatrics | 39242 Dequindre Rd Ste 101, Sterling Heights, MI 48310-1764 | 2018-05-07 |
| 1073010625 | Vernor Pediatric PC | Pediatrics | 4607 W Vernor Hwy, Detroit, MI 48209-2117 | 2018-04-10 |
| 1801257738 | Alshefa Family Practice Pllc | Pediatrics | 28780 Ryan Rd, Suite B, Warren, MI 48092-2521 | 2016-03-20 |
| 1497130132 | Branch Pediatric&adolescent Medicinepc | Pediatrics | 360 E Chicago St Ste 101, Coldwater, MI 49036-2086 | 2015-07-23 |
| 1700277977 | Spectrum Health United | Pediatrics | 318 S Bridge St, Belding, MI 48809-1764 | 2015-02-10 |
| 1477943900 | Pediatric & Adolescent Clinic of Michigan | Pediatrics | 37375 Curtis Rd, Livonia, MI 48152-4090 | 2015-02-04 |
| 1316360043 | William Waters | Pediatrics | 981 Townline Rd, Charlevoix, MI 49720-8970 | 2014-01-31 |
| 1114348596 | Southwest Pediatrics Pllc | Pediatrics | 37672 Professional Center Dr Ste 120, Livonia, MI 48154-1140 | 2014-01-02 |
| 1467889386 | Community Health Center of Branch County | Pediatrics | 450 E Grant St, Bronson, MI 49028-1524 | 2013-10-09 |
| 1851687107 | Community Health Center of Branch County | Pediatrics | 18 Colfax St, Quincy, MI 49082-1139 | 2011-06-24 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMFIELD HILLS |
| Zip Code | 48302 |
Please comment or provide details below to improve the information on MAUREEN A KELLY MD PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.