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NPI Code Detail

MEDICARE: MICHAEL SCOTT KENLY M.D.

MEDICARE: MICHAEL SCOTT KENLY 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
1208100000XPhysical Medicine & Rehabilitation Physician62730GA
2208100000XPhysical Medicine & Rehabilitation PhysicianA113590CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EJ158ZOTHERCASOUTHERN MEDICARE PTAN
2EJ158YOTHERCANORTHERN MEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3A113590OTHERCADCA MEDICAL LICENSE

General Provider Information

NPI Number : 1548445307
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL SCOTT KENLY M.D.
Provider Business Mailing Address
First Line : 511 BATH ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-3403
Country : US
Telephone Number : 805-963-9377
Fax Number : 805-962-2154
Provider Business Practice Location Address
First Line : 511 BATH ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-3403
Country : US
Telephone Number : 805-963-9377
Fax Number : 805-962-2154
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2007
Last Update Date : 08/19/2015

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Directions to “ MICHAEL SCOTT KENLY M.D.” Practice Location

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