DR. JEFFREY JOHN KELLY (NPI# 1770565384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770565384 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY JOHN KELLY |
| Credential | D.O. |
| Practice Address |
3643 W Front St Suite A Traverse City MI 49684-7759 |
| Practice Telephone | 2319350620 |
| Practice Fax Number | 2319350626 |
| Mailing Telephone | 2319350620 |
| Mailing Fax Number | 2319350626 |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2013-07-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 5101020217 | MI | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 055534 | GA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255750840 | Jeffrey Kelly | Specialist/Technologist | 7220 N Lindbergh, Salyer Perfusion Blvd Ste 360, St. Louis, MO 63042 | 2014-04-10 |
| 1508338294 | Jeffrey Glen Kelly Sr. | Behavior Technician | 4540 Harlin Dr, Sacramento, CA 95826-9716 | 2018-12-19 |
| 1194898544 | Jeffrey Kelly | Physician Assistant | 1800 Mulberry St, Scranton, PA 18510-2369 | 2006-11-15 |
| 1932159928 | Jeffrey Alan Kelly | Chiropractor | 4266 State St, Saginaw, MI 48603-4028 | 2006-05-11 |
| 1477538353 | Jeffrey Scott Kelly | Anesthesiology | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-12-13 |
| Street Address |
3643 W FRONT ST SUITE A |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-7759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487646923 | John J Gorman | Internal Medicine | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2005-08-19 |
| 1588876254 | Mary Bonnie Smith | Nurse Practitioner | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2007-05-04 |
| 1730208349 | Amy Lynn Ream | Specialist/Technologist | 3643 W Front St, Suite B, Traverse City, MI 49684-7759 | 2007-03-28 |
| 1831224765 | Curt Jeffrey Schubert | Internal Medicine | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2007-02-22 |
| 1528168895 | Northern Michigan Medicine and Pediatrics, Pllc | Pediatrics | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2006-09-25 |
| 1861430779 | Associates In Dermatology of Traverse City PC | Dermatology | 3643 W Front St, Traverse City, MI 49684-7759 | 2006-06-03 |
| 1871585174 | Margaret J Meeker | Pediatrics | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2005-08-22 |
| 1295727774 | Walter K Meeker | Internal Medicine | 3643 W Front St, Suite C, Traverse City, MI 49684 | 2005-08-19 |
| 1104818681 | Robert E Kuhn | Internal Medicine | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2005-08-19 |
| 1922090406 | Sherry L Small | Pediatrics | 3643 W Front St, Suite C, Traverse City, MI 49684-7759 | 2005-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679990758 | Brittany Channing-noble Lister | Dermatology | 550 Munson Ave Ste 200, Traverse City, MI 49686-3580 | 2014-03-26 |
| 1871851105 | Anthony C Vanvreede | Dermatology | 1225 W Front St Ste C, Traverse City, MI 49684-2368 | 2012-04-24 |
| 1801185202 | Patrick John Tobin | Dermatology | 7777 Truesdale Ln, Traverse City, MI 49686-1667 | 2011-04-06 |
| 1437268661 | Maria C Carroll | Dermatology | 550 Munson Ave, Suite 200, Traverse City, MI 49686 | 2006-08-30 |
| 1770692873 | Susan C Noble | Dermatology | 550 Munson Avenue, Suite 200, Traverse City, MI 49686 | 2006-08-30 |
| 1922536986 | V Dermatology | Dermatology | 1225 W Front St Ste C, Traverse City, MI 49684-2368 | 2017-06-02 |
| 1952410094 | Northwestern Michigan Dermatology PC | Dermatology | 550 Munson Ave, Suite 200, Traverse City, MI 49686-3580 | 2006-08-30 |
| 1285743393 | Paula L Cahill | Dermatology | 550 Munson Ave, Suite 200, Traverse City, MI 49686 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710595616 | Diamond Dermatology, Pllc. | Dermatology | 3206 N Main St, Royal Oak, MI 48073-3424 | 2020-07-16 |
| 1477179174 | Alicia Scopis | Dermatology | 50505 Schoenherr Rd Ste 325, Shelby Township, MI 48315-3142 | 2020-06-18 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1770080939 | Emily Rose Davis | Dermatology | 5333 Mcauley Dr Rm 2111, Ypsilanti, MI 48197-1097 | 2018-04-12 |
| 1245744242 | Maureen Cliffel Do Pllc | Dermatology | 26454 Woodward Ave Ste 200, Royal Oak, MI 48067-0969 | 2017-11-29 |
| 1306375365 | Lindsay Christina El Awadi | Dermatology | 50182 Schoenherr Rd, Shelby Twp, MI 48315-3136 | 2017-06-05 |
| 1396278099 | Sasank Konda | Dermatology | 3031 W. Grand Blvd., 8th Floor, Dept. of Dermatology, Detroit, MI 48202 | 2017-04-10 |
| 1790132439 | Saara Kanervikkoaho-crane | Dermatology | 1517 Granger Ave, Ann Arbor, MI 48104-4426 | 2016-05-23 |
| 1588019053 | Legacy Dermatology Group PC | Dermatology | 1392 S Cass Lake Rd, Waterford, MI 48328 | 2016-05-03 |
| 1679955041 | Luke D Killpack | Dermatology | 5333 Mcauley Dr Rm 5003, Ypsilanti, MI 48197-1020 | 2015-06-22 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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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.