Provider Demographics
NPI:1336367077
Name:DAVID R KELLEY INC
Entity Type:Organization
Organization Name:DAVID R KELLEY INC
Other - Org Name:LIVINGSTON HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-632-0900
Mailing Address - Street 1:12319 HIGHLAND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2946
Mailing Address - Country:US
Mailing Address - Phone:810-632-0900
Mailing Address - Fax:810-632-0800
Practice Address - Street 1:12319 HIGHLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2946
Practice Address - Country:US
Practice Address - Phone:810-632-0900
Practice Address - Fax:810-632-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000165237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty