DR. JAY EMERSON KELLAWAY (NPI# 1629129200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629129200 |
| Entity Type | Individual |
| Full Name | DR. JAY EMERSON KELLAWAY |
| Credential | M.D. |
| Practice Address |
10229 Lakeshore Dr West Olive MI 49460-9554 |
| Practice Telephone | 6168426757 |
| Practice Fax Number | 6168427256 |
| Mailing Telephone | 6168426757 |
| Mailing Fax Number | 6168427256 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
1686290 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
10229 LAKESHORE DR |
| City | WEST OLIVE |
| State | MI |
| Zip Code | 49460-9554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902255714 | Matthew Tornga | Family Medicine | 15151 Stanton St Ste A, West Olive, MI 49460 | 2016-06-13 |
| 1407326648 | Bryan Castillo | Physical Therapist | 14715 Mayberry Dr, Port Sheldon, MI 49460-4946 | 2018-11-30 |
| 1699119412 | Ronald Dean Mulder | Obstetrics & Gynecology | 17236 Sandgate Pl, West Olive, MI 49460-8508 | 2013-04-23 |
| 1184610669 | Jack Richard Roossien Jr. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2005-09-21 |
| 1598223612 | Lindsey Ann Roossien | Family Medicine | 15151 Stanton St, West Olive, MI 49460-8543 | 2019-03-07 |
| 1609069244 | Eileen Marie Kishman | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2007-08-27 |
| 1497947618 | Physiotherapy Associates Inc | Clinic/Center | 15151 Stanton St, Ste B, West Olive, MI 49460-8543 | 2007-08-11 |
| 1740406982 | Jack R. Roossien Jr., M.d.p.c. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2007-04-17 |
| 1427086420 | Wendy L Bradley | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-29 |
| 1609802313 | Stanton Crossings Physical Therapy LLC | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-24 |
| Find all providers in zip 49460 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| 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 Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245855667 | Joshua Boulter | Radiology | 2250 Providence Drive, 3pmb Suite #301, Southfield, MI 48075-4818 | 2020-06-11 |
| 1679197693 | Shyam Amin | Radiology | Academic Internal Medicine 2 2250 Providence Dr, 3pmb Suite #301, Southfield, MI 48075-4818 | 2020-06-05 |
| 1871116509 | Anthony Diebes | Radiology | 16001 W 9 Mile Rd Bldg 4th, Southfield, MI 48075-4818 | 2020-05-28 |
| 1548823800 | Alexander Paul Kaechele | Radiology | 16001 West 9 Mile Road, Suite #416, Southfield, MI 48075-4818 | 2019-04-22 |
| 1790246627 | Genesis Healthcare | Radiology | 8560 N Silvery Ln Ste 101, Dearborn Heights, MI 48127-4516 | 2019-03-25 |
| 1023572831 | Proscan Imaging Southfield Pllc | Radiology | 29877 Telegraph Rd # 11, Southfield, MI 48034-1332 | 2019-01-25 |
| 1295204253 | Easy Imaging, LLC | Radiology | 16100 19 Mile Rd Ste X, Clinton Township, MI 48038-1148 | 2018-11-20 |
| 1205304888 | Ascension Medical Group Genesys | Radiology | 1096 S Belsay Rd Ste J, Burton, MI 48509-1948 | 2018-11-13 |
| 1336626696 | Quantum Medical Radiology of California, P.C. | Radiology | 1625 Bear Creek Ln Unit O, Petoskey, MI 49770-8378 | 2018-07-19 |
| 1376072488 | Cambridge Institute of Minimally Invasive Therapies Pllc | Radiology | 2007 E 14 Mile Rd, Sterling Heights, MI 48310-5905 | 2017-06-12 |
| Find all providers with the same taxonomy | ||||
| City | WEST OLIVE |
| Zip Code | 49460 |
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| 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.