Provider Demographics
NPI:1417988874
Name:KELLETT, MICHAEL PARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PARRIS
Last Name:KELLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6300
Mailing Address - Country:US
Mailing Address - Phone:864-454-2143
Mailing Address - Fax:864-454-1144
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 330
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4247
Practice Address - Country:US
Practice Address - Phone:864-233-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6112207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4651521OtherAETNA
SC57-1004971032OtherBCBS OF SC
SC1575427OtherCIGNA
SC061122Medicaid
SC061122Medicaid