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General NPI Number Information
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NPI Number | 1154809002
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Entity Type | Individual
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Provider Name | STEVEN ELLSWORTH KELLY MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 62 E THRIVE DR STE 220
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-5560
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Country | US
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Telephone | 801-768-8800
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Fax | 801-820-8200
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Provider Business Mailing Address
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Address Line | 680 E MAIN ST
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City | LEHI
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State | UT
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Zip | 84043-2241
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Country | US
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Telephone | 801-768-8800
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Fax | 801-820-8200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12750920-1205
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License Number State | UT
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