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General NPI Number Information
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NPI Number | 1396816047
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Entity Type | Organization
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Legal Business Name | WILLIAM M. KELLY M.D., INC.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 29798 HAUN RD. SUITE 103
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City | SUN CITY
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State | CA
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Zip | 92586-6541
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Country | US
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Telephone | 951-244-6700
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Fax | 951-244-6788
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Provider Business Mailing Address
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Address Line | 44489 TOWN CENTER WAY STE. D
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City | PALM DESERT
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State | CA
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Zip | 92260-2789
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Country | US
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Telephone | 760-776-9777
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Fax | 760-776-4999
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | MS. MELONIE STORER
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Credential |
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Telephone | 951-302-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number | A34125
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License Number State | CA
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