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NPI Code Detail

MEDICARE: MICHAEL KELLY M.D.

MEDICARE: MICHAEL KELLY 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
1207L00000XAnesthesiology PhysicianA69217CA
2207LP2900XPain Medicine (Anesthesiology) PhysicianA69217CA

General Provider Information

NPI Number : 1891761276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KELLY M.D.
Provider Business Mailing Address
First Line : PO BOX 7001
Second Line :
City : TARZANA
State : CA
Zip : 91357-7001
Country : US
Telephone Number : 818-888-7815
Fax Number : 818-715-1722
Provider Business Practice Location Address
First Line : 3828 DELMAS TER
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-2713
Country : US
Telephone Number : 310-836-7000
Fax Number : 818-715-1722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 01/20/2011

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