MEDICARE: DR. NAVEEN KELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	L5784	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB159055	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154301182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAVEEN KELLA M.D.

Provider Business Mailing Address
First Line	:	9618 HUEBNER ROAD , SUITE 120
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1660
Country	:	US
Telephone Number	:	210-617-3670
Fax Number	:	888-316-9464

Provider Business Practice Location Address
First Line	:	9618 HUEBNER ROAD , SUITE 120
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240
Country	:	US
Telephone Number	:	210-617-3670
Fax Number	:	888-316-9464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/08/2018

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Directions to “ DR. NAVEEN KELLA M.D.” Practice Location

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