Healthcare Provider Details

I. General information

NPI: 1083061253
Provider Name (Legal Business Name): KATE ELIZABETH KIELY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. KATE ELIZABETH KIELY

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 E ALLUVIAL AVE STE 101
FRESNO CA
93720-2686
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-6226
  • Fax: 559-440-9005
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA186890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: