Basic Information
| Provider Information | |||||||||
| NPI: | 1538432729 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANIEL F. KELLY NEUROSURGICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 SANTA MONICA BLVD | ||||||||
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| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105827450 | ||||||||
| FaxNumber: | 3105827495 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 SANTA MONICA BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105827450 | ||||||||
| FaxNumber: | 3105827495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3105827450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.