DR. KELLY HEFFERON (NPI# 1255474813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255474813 |
| Entity Type | Individual |
| Full Name | DR. KELLY HEFFERON |
| Credential | D.O. |
| Practice Address |
21650 W 11 Mile Rd Ste 209 Southfield MI 48076-3777 |
| Mailing Address |
24567 Northwestern Hwy Ste 150 Southfield MI 48075-2421 |
| Practice Telephone | 2488099638 |
| Practice Fax Number | 2488099996 |
| Mailing Telephone | 2487990093 |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2019-11-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
5101012396 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
21650 W 11 MILE RD STE 209 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48076-3777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942813753 | Elaine Sarah Kahn | Social Worker | 15999 West Twelve Mile Rd, Southfield, MI 48076 | 2020-08-31 |
| 1295353829 | Marian Hannah Ibrahim | Dentist | 19189 W 12 Mile Rd, Lathrup Village, MI 48076 | 2020-07-09 |
| 1699317669 | Meadow Lane Rehabilitative Therapies LLC | Social Worker | 29895 Greenfield Rd., Suite 104b, Southfield, MI 48076 | 2019-10-11 |
| 1760035752 | Taliah Laneice Williams-hunter | Counselor | 30119 Sparkleberry Dr., Southfield, MI 48076 | 2019-07-19 |
| 1386114742 | Mavis Gail Pookrum | Technician | 21732 Colony Park Circle #105, Southfield, MI 48076 | 2018-11-28 |
| 1861962417 | Millennial Infusion Centers Inc | Clinic/Center | 26250 Northwestern Hwy Ste 201, Southfield, MI 48076 | 2018-11-27 |
| 1215429212 | Debra Deanes | Counselor | 30233 Southfiels Rd, 203, Southfield, MI 48076 | 2018-06-05 |
| 1437675758 | Kenneth Gerard Giles | Counselor | 29532 Southfield Rd. Suite 208, Southfield, MI 48076 | 2017-08-17 |
| 1902346836 | Linsk Psychiatry Services P C | Clinic/Center | 21751 W 12 Mile Rd, Suite 205, Southfield, MI 48076 | 2017-02-25 |
| 1023552361 | Massage Serenity | Community/Behavioral Health | 20245 W. 12 Mile Rd, Suite 113, Southfield, MI 48076 | 2016-12-06 |
| Find all providers in zip 48076 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700152014 | Nicholas Joseph | Internal Medicine | 24463 W 10 Mile Rd, Pace Southeast Michigan, Southfield, MI 48033-2931 | 2012-03-30 |
| 1043314164 | William Stuart Gonte | Internal Medicine | 29877 Telegraph, Ste 401, Southfield, MI 48034 | 2006-09-11 |
| 1972605707 | Md House Calls, Pllc | Internal Medicine | 27760 Franklin Rd, Southfield, MI 48034-2300 | 2006-09-02 |
| 1760445878 | Juan Manuel Perez | Internal Medicine | 24445 Northwestern Hwy, Suite 206, Southfield, MI 48075-6501 | 2006-04-10 |
| 1851798235 | Express Physicians Limited Liability Partnership | Internal Medicine | 17330 Northland Park Ct, Southfield, MI 48075-4318 | 2014-12-01 |
| 1245633411 | Platinum Care Physicians PC | Internal Medicine | 27207 Lahser Rd, Suite 250, Southfield, MI 48034-2168 | 2014-10-02 |
| 1548683246 | Global Health Services Pllc | Internal Medicine | 29508 Southfield Rd, Suite #202, Southfield, MI 48076-2022 | 2014-01-31 |
| 1083789358 | Robert Legg | Internal Medicine | 24445 Northwestern Hwy, Suite # 206, Southfield, MI 48075-6501 | 2006-11-22 |
| 1700950607 | Lake Mi Mobile Doctors, P.C. | Internal Medicine | 24445 Northwestern Hwy, Suite #206, Southfield, MI 48075-6501 | 2006-11-20 |
| 1972672103 | Arthur A Efros | Internal Medicine | 28625 Northwestern Hwy, Suite 213, Southfield, MI 48034-1828 | 2006-11-06 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48076 |
Please comment or provide details below to improve the information on DR. KELLY HEFFERON.
| 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.