Provider Demographics
NPI:1790042620
Name:KELLY-SELL, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:KELLY-SELL
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 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:469-532-0273
Practice Address - Street 1:5060 TENNYSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4170
Practice Address - Country:US
Practice Address - Phone:214-556-5695
Practice Address - Fax:469-609-2962
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9509207N00000X, 207ND0101X, 207R00000X, 207ND0101X
PAMT201022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine