Provider Demographics
NPI:1154301182
Name:KELLA, NAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:
Last Name:KELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9618 HUEBNER ROAD , SUITE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1660
Mailing Address - Country:US
Mailing Address - Phone:210-617-3670
Mailing Address - Fax:888-316-9464
Practice Address - Street 1:9618 HUEBNER ROAD , SUITE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-617-3670
Practice Address - Fax:888-316-9464
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL5784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161561903Medicaid
TXTXB159055OtherMEDICARE PTAN
TX161561903Medicaid