Provider Demographics
NPI:1316048408
Name:KELLEY, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:HEME/ONC (111G)
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:919-286-6896
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:HEME/ONC (111G)
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6896
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC32252207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCOTH000Medicare UPIN