Provider Demographics
NPI:1063477008
Name:MCKELVEY, MICHAEL TODD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N HAMILTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8708
Mailing Address - Country:US
Mailing Address - Phone:614-473-9519
Mailing Address - Fax:614-473-9543
Practice Address - Street 1:925 N HAMILTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8708
Practice Address - Country:US
Practice Address - Phone:614-473-9519
Practice Address - Fax:614-473-9543
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI63126Medicare UPIN
OHMC4195371Medicare PIN