Provider Demographics
NPI:1790365286
Name:KELLEY, ELIJAH (DO)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 OLD TROY PIKE STE 240
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1053
Mailing Address - Country:US
Mailing Address - Phone:937-396-2880
Mailing Address - Fax:937-396-2205
Practice Address - Street 1:8701 OLD TROY PIKE STE 240
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1053
Practice Address - Country:US
Practice Address - Phone:937-396-2880
Practice Address - Fax:937-396-2205
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine