Provider Demographics
NPI:1326240631
Name:KELLEY, TODD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHIPETA WAY
Mailing Address - Street 2:ARUP LABORATORIES, MEDICAL DIRECTORS
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1221
Mailing Address - Country:US
Mailing Address - Phone:801-583-2787
Mailing Address - Fax:801-585-3831
Practice Address - Street 1:500 CHIPETA WAY
Practice Address - Street 2:ARUP LABORATORIES, MEDICAL DIRECTORS
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1221
Practice Address - Country:US
Practice Address - Phone:801-583-2787
Practice Address - Fax:801-585-3831
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6508197-1205207ZP0102X
OH35.087190207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology