MEDICARE: DR. LEON KELLY MD

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	207ZF0201X	Forensic Pathology Physician	45381	CO

General Provider Information

NPI Number	:	1710542022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON KELLY MD

Provider Business Mailing Address
First Line	:	3010 SHEIKS PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-1138
Country	:	US
Telephone Number	:	719-310-7835
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 E LAS VEGAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-1594
Country	:	US
Telephone Number	:	719-390-2450
Fax Number	:

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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