Provider Demographics
NPI:1841289956
Name:RILEY, HUGH KELLEY (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:KELLEY
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4600 BRETON RD SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5262
Mailing Address - Country:US
Mailing Address - Phone:616-656-8600
Mailing Address - Fax:616-656-8601
Practice Address - Street 1:4600 BRETON RD SE
Practice Address - Street 2:SUITE 103
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5262
Practice Address - Country:US
Practice Address - Phone:616-656-8600
Practice Address - Fax:616-656-8601
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4695088Medicaid