Provider Demographics
NPI:1760740997
Name:KELLY WOLF & HERMAN M D P A
Entity Type:Organization
Organization Name:KELLY WOLF & HERMAN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-595-2969
Mailing Address - Street 1:8940 N KENDALL DR STE 903E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2176
Mailing Address - Country:US
Mailing Address - Phone:305-595-2969
Mailing Address - Fax:305-595-6491
Practice Address - Street 1:8940 N KENDALL DR STE 903E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2176
Practice Address - Country:US
Practice Address - Phone:305-595-2969
Practice Address - Fax:305-595-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1396845640OtherINDIVIDUAL NPI
FL1942380167OtherMICHAEL E. KELLY M.D., INDIVIDUAL NPI
FL1194825497OtherBRAD P. HERMAN M.D., INDIVIDUAL NPI
FL1053503672OtherJOHNNY FRANCO, M.D. INDIVIDUAL NPI