Provider Demographics
NPI:1144243361
Name:KEALEY, KRIS C (MD)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:C
Last Name:KEALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:STE 302
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-750-5995
Mailing Address - Fax:415-666-3144
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:STE 302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-750-5995
Practice Address - Fax:415-666-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101480Medicaid
CAZZZ31832ZMedicare ID - Type Unspecified
G24082Medicare UPIN
CAGR0101480Medicaid