Provider Demographics
NPI:1952398265
Name:M & K PODIATRIC MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:M & K PODIATRIC MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-270-0295
Mailing Address - Street 1:4314 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1334
Mailing Address - Country:US
Mailing Address - Phone:818-843-6611
Mailing Address - Fax:818-843-6656
Practice Address - Street 1:4314 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1334
Practice Address - Country:US
Practice Address - Phone:818-843-6611
Practice Address - Fax:818-843-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4536213ES0103X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5723590001Medicare NSC
CAWE4536CMedicare PIN
CAW20114Medicare UPIN
CAV02021Medicare UPIN
CAWE4686BMedicare PIN