Provider Demographics
NPI:1801104153
Name:KESTI, KELLY L (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:KESTI
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:56901 S 6TH ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2946
Mailing Address - Country:US
Mailing Address - Phone:906-337-5252
Mailing Address - Fax:906-337-5254
Practice Address - Street 1:56901 S 6TH ST
Practice Address - Street 2:STE. 1
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2946
Practice Address - Country:US
Practice Address - Phone:906-337-5252
Practice Address - Fax:906-337-5254
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004670152W00000X
WI3201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist