Provider Demographics
NPI:1598070427
Name:DARKE, KELLY (MED)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DARKE
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 1:31473 CAPRI TER APT 801
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2467
Mailing Address - Country:US
Mailing Address - Phone:734-502-7920
Mailing Address - Fax:
Practice Address - Street 1:31473 CAPRI TER APT 801
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2467
Practice Address - Country:US
Practice Address - Phone:734-502-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No171W00000XOther Service ProvidersContractor