MEDICARE: DANIEL KELETI M.D.

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
1	2085R0001X	Radiation Oncology Physician	118429	MO
2	2085R0001X	Radiation Oncology Physician	04-28194	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356325245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL KELETI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 411851
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-1851
Country	:	US
Telephone Number	:	913-574-2800
Fax Number	:	913-574-2336

Provider Business Practice Location Address
First Line	:	300 NW MOCK AVE
Second Line	:	STE. 100
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2543
Country	:	US
Telephone Number	:	816-655-5592
Fax Number	:	816-655-5593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	05/09/2016

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