Provider Demographics
NPI:1437680204
Name:CELTIK, KENAN EROL (MD)
Entity Type:Individual
Prefix:
First Name:KENAN
Middle Name:EROL
Last Name:CELTIK
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 1:575 SIR FRANCIS DRAKE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2307
Mailing Address - Country:US
Mailing Address - Phone:415-625-3230
Mailing Address - Fax:
Practice Address - Street 1:575 SIR FRANCIS DRAKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2307
Practice Address - Country:US
Practice Address - Phone:415-625-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184663208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology