Provider Demographics
NPI:1740547520
Name:KELLY, MARIEN RODRIGUEZ (DPM)
Entity type:Individual
Prefix:
First Name:MARIEN
Middle Name:RODRIGUEZ
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 BULL RUN RD APT 380H
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2191
Mailing Address - Country:US
Mailing Address - Phone:786-368-6815
Mailing Address - Fax:
Practice Address - Street 1:3146 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3210
Practice Address - Country:US
Practice Address - Phone:786-536-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3679213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist