Provider Demographics
NPI:1356546378
Name:MENGE, KELLY ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ROSE
Last Name:MENGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:901 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849
Mailing Address - Country:US
Mailing Address - Phone:906-485-2665
Mailing Address - Fax:906-485-2731
Practice Address - Street 1:901 LAKESHORE DR.
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849
Practice Address - Country:US
Practice Address - Phone:906-485-2665
Practice Address - Fax:906-485-2731
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology