MEDICARE: DR. ANDREW KELADA D.O.

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	207Q00000X	Family Medicine Physician	U3564	TX

General Provider Information

NPI Number	:	1659909463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW KELADA D.O.

Provider Business Mailing Address
First Line	:	1201 2ND AVE STE 1400
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-3039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 S ALAMEDA ST STE 200
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-1753
Country	:	US
Telephone Number	:	361-724-3220
Fax Number	:

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

Provider Enumeration Date	:	03/28/2020
Last Update Date	:	07/30/2024

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