| Kelly Otp Llc | |
|
25200 Kelly Rd Roseville MI 48066-4473 | |
| (586) 422-1250 | |
| Not Available |
| Full Name | Kelly Otp Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 25200 Kelly Rd, Roseville, Michigan |
| Authorized Official Name and Position | Aaron Douglas Alston (PRATICE ADMINISTRATOR) |
| Authorized Official Contact | 2489710150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Otp Llc 7 Riverbank Dr Beverly Hills MI 48025-4800 Ph: (248) 971-0150 | Kelly Otp Llc 25200 Kelly Rd Roseville MI 48066-4473 Ph: (586) 422-1250 |
| NPI Number | 1265150767 |
|---|---|
| Provider Enumeration Date | 08/19/2022 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Medicare PECOS PAC ID | 0446636385 |
|---|---|
| Medicare Enrollment ID | O20220930000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265150767 | NPI | - | NPPES |
| Provider Name | Jason Noel Peter |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1851581789 PECOS PAC ID: 1759464795 Enrollment ID: I20080213000603 |
| Provider Name | James Shirley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1427176429 PECOS PAC ID: 9830243203 Enrollment ID: I20090819000555 |
| Provider Name | Amanda Louise Stamm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588826556 PECOS PAC ID: 4082992573 Enrollment ID: I20161104000129 |
| Provider Name | Randy A Pierce |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1578981932 PECOS PAC ID: 6507175320 Enrollment ID: I20190606002191 |
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