Basic Information
| Provider Information | |||||||||
| NPI: | 1154507580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | HOSPITAL ROOM 2195 MAIL STOP 1137 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833556 | ||||||||
| FaxNumber: | 4193833550 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | HOSPITAL ROOM 2195 MAIL STOP 1137 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833556 | ||||||||
| FaxNumber: | 4193833550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 01/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35.088730 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.