Provider Demographics
NPI:1558068080
Name:KELLOGG, MICHELLE (MED)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ROYAL GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4521
Mailing Address - Country:US
Mailing Address - Phone:513-835-9040
Mailing Address - Fax:
Practice Address - Street 1:2505 ROYAL GLEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4521
Practice Address - Country:US
Practice Address - Phone:513-835-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant