Healthcare Provider Details

I. General information

NPI: 1548445307
Provider Name (Legal Business Name): MICHAEL SCOTT KENLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BATH ST
SANTA BARBARA CA
93101-3403
US

IV. Provider business mailing address

511 BATH ST
SANTA BARBARA CA
93101-3403
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-9377
  • Fax: 805-962-2154
Mailing address:
  • Phone: 805-963-9377
  • Fax: 805-962-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number62730
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA113590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: