Provider Demographics
NPI:1215373451
Name:DONOVAN, KELLY R (DO)
Entity Type:Individual
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First Name:KELLY
Middle Name:R
Last Name:DONOVAN
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1400 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7823
Mailing Address - Country:US
Mailing Address - Phone:231-935-8000
Mailing Address - Fax:231-935-8099
Practice Address - Street 1:550 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3580
Practice Address - Country:US
Practice Address - Phone:231-935-8686
Practice Address - Fax:231-935-8099
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2023-05-29
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Provider Licenses
StateLicense IDTaxonomies
MI5101020231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine