| Organization Name: | KELLY M HEFFERON DO PC |
| NPI Number: | 1518354745 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY M HEFFERON (DIRECTOR) |
| Mailing Address: | 5114 Shenandoah Ct W Bloomfield |
| State: | MI US |
| Postal Code: | 483232343 |
| Phone Number: | 2482301780 |
| Fax Number: | |
| NPI Enumeration Date: | 04/27/2015 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |