Provider Demographics
NPI:1598747941
Name:ORTWINE, KELLY Z (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:Z
Last Name:ORTWINE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 240
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-997-7000
Mailing Address - Fax:248-997-7007
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 240
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-997-7000
Practice Address - Fax:248-997-7007
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-01-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301070293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4307599Medicaid
MI4307599Medicaid
H17193Medicare UPIN