MEDICARE: NAVEEN KELLA MD PA

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	174400000X	Specialist	L5784	TX

General Provider Information

NPI Number	:	1659779155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVEEN KELLA MD PA

Provider Business Mailing Address
First Line	:	9618 HUEBNER RD STE 120
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1775
Country	:	US
Telephone Number	:	210-617-3670
Fax Number	:	888-316-9464

Provider Business Practice Location Address
First Line	:	9618 HUEBNER ROAD , SUITE 120
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1660
Country	:	US
Telephone Number	:	210-617-3670
Fax Number	:	888-316-9464

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	NAVEEN KELLA
Credential	:	M.D.
Telephone Number	:	210-617-3670

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	01/22/2021

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