Provider Demographics
NPI:1548255128
Name:KELEN, GEORGE JOHN (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOHN
Last Name:KELEN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E LUDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2191
Mailing Address - Country:US
Mailing Address - Phone:231-425-4590
Mailing Address - Fax:231-425-4588
Practice Address - Street 1:102 E LUDINGTON AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2191
Practice Address - Country:US
Practice Address - Phone:231-425-4590
Practice Address - Fax:231-425-4588
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079843246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4579580Medicaid
MIDA9989OtherRAILROAD MEDICARE
MIDA9989OtherRAILROAD MEDICARE
MI4579580Medicaid