Provider Demographics
NPI:1497863039
Name:KELLY, ROBERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14601 DETROIT RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-237-5500
Mailing Address - Fax:216-237-5670
Practice Address - Street 1:14601 DETROIT RD FL 2
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-237-5500
Practice Address - Fax:216-237-5670
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35048873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0523839Medicaid
OHD31385Medicare UPIN
OH0523839Medicaid