Provider Demographics
NPI:1144429747
Name:BENEDICT, KELLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:BENEDICT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2545 E THOMAS RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7969
Mailing Address - Country:US
Mailing Address - Phone:602-903-1532
Mailing Address - Fax:602-956-0567
Practice Address - Street 1:3333 E CAMELBACK RD
Practice Address - Street 2:STE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2322
Practice Address - Country:US
Practice Address - Phone:602-997-0484
Practice Address - Fax:602-224-3315
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2017-03-01
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ491622080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ921982Medicaid