MEDICARE: JON A KELLY D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC-003063-L	PA

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	602340	OTHER	PA	HIGHMARK BCBS

General Provider Information

NPI Number	:	1396761268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON A KELLY D.P.M.

Provider Business Mailing Address
First Line	:	1601 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1720
Country	:	US
Telephone Number	:	412-673-9222
Fax Number	:	412-673-0022

Provider Business Practice Location Address
First Line	:	1601 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1720
Country	:	US
Telephone Number	:	412-673-9222
Fax Number	:	412-673-0022

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/12/2010

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