Provider Demographics
NPI:1255347373
Name:KELLEY, FRANK (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 KUMHO DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9297
Mailing Address - Country:US
Mailing Address - Phone:330-576-0500
Mailing Address - Fax:330-576-0467
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:STE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-089888207R00000X
OH35069688208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000487210OtherANTHEM
OHP00344835OtherRAILROAD MEDICARE
OH5563308OtherAETNA
OH2033043Medicaid
OH$$$$$$$$$018OtherMEDICAL MUTUAL
OH$$$$$$$$$018OtherMEDICAL MUTUAL
OH5563308OtherAETNA