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NPI Code Detail

MEDICARE: DR. PARDIS A KELLY DPM

MEDICARE: DR. PARDIS A KELLY DPM
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
1213E00000XPodiatristE41580CA
2213E00000XPodiatrist2063NV

General Provider Information

NPI Number : 1487684189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PARDIS A KELLY DPM
Provider Business Mailing Address
First Line : 8550 W CHARLESTON BLVD
Second Line : STE 102 PMB 396
City : LAS VEGAS
State : NV
Zip : 89117-5000
Country : US
Telephone Number : 650-303-5100
Fax Number : 650-595-3013
Provider Business Practice Location Address
First Line : 9940 W FLAMINGO ROAD
Second Line : SUITE 101
City : LAS VEGAS
State : NV
Zip : 89147
Country : US
Telephone Number : 702-605-6220
Fax Number : 702-605-5880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 02/15/2021

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