MEDICARE: M & K PODIATRIC MEDICAL MANAGEMENT

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	332BC3200X	Customized Equipment (DME)	E4536	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E4536	CA

General Provider Information

NPI Number	:	1952398265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & K PODIATRIC MEDICAL MANAGEMENT

Provider Business Mailing Address
First Line	:	4314 W VICTORY BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1334
Country	:	US
Telephone Number	:	818-843-6611
Fax Number	:	818-843-6656

Provider Business Practice Location Address
First Line	:	4314 W VICTORY BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1334
Country	:	US
Telephone Number	:	818-843-6611
Fax Number	:	818-843-6656

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ARA KELEKIAN
Credential	:	D.P.M.
Telephone Number	:	323-270-0295

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	01/28/2008

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