Provider Demographics
NPI:1235423708
Name:BROSSY, KELLEY JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:JAMES
Last Name:BROSSY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21243 ROBINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5081
Mailing Address - Country:US
Mailing Address - Phone:909-563-0906
Mailing Address - Fax:
Practice Address - Street 1:21031 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2339
Practice Address - Country:US
Practice Address - Phone:313-277-6700
Practice Address - Fax:313-277-2483
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019337207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery